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Archive: 1993-2003
Mental Health Information and Statistics

Mental Disorders in America
Mental disorders are common in the United States and internationally. An estimated 22.1 percent of Americans ages 18 and older--about 1 in 5 adults--suffer from a diagnosable mental disorder in a given year. When applied to the 1998 U.S. Census residential population estimate, this figure translates to 44.3 million people. In addition, 4 of the 10 leading causes of disability in the U.S. and other developed countries are mental disorders--major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. Many people suffer from more than one mental disorder at a given time.

Depressive Disorders
Depressive disorders encompass major depressive disorder, dysthymic disorder, and bipolar disorder. Bipolar disorder is included because people with this illness have depressive episodes as well as manic episodes.

  • Approximately 18.8 million American adults, 5 or about 9.5 percent of the U.S. population age 18 and older in a given year, 1 have a depressive disorder.
  • Nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year. These figures translate to 12.4 million women and 6.4 million men in the U.S.
  • Depressive disorders may be appearing earlier in life in people born in recent decades compared to the past.
  • Depressive disorders often co-occur with anxiety disorders and substance abuse.

    Major Depressive Disorder

    • Major depressive disorder is the leading cause of disability in the U.S. and established market economies worldwide.
    • Major depressive disorder affects approximately 9.9 million American adults, or about 5.0 percent of the U.S. population age 18 and older in a given year.
    • Nearly twice as many women (6.5 percent) as men (3.3 percent) suffer from major depressive disorder each year. These figures translate to 6.7 million women and 3.2 million men.
    • While major depressive disorder can develop at any age, the average age at onset is the mid-20s.

    Dysthymic Disorder

    • Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least 2 years in adults (1 year in children) to meet criteria for the diagnosis.
    • Dysthymic disorder affects approximately 5.4 percent of the U.S. population age 18 and older during their lifetime. This figure translates to about 10.9 million American adults.
    • About 40 percent of adults with dysthymic disorder also meet criteria for major depressive disorder or bipolar disorder in a given year.
    • Dysthymic disorder often begins in childhood, adolescence, or early adulthood.

    Bipolar Disorder

    • Bipolar disorder affects approximately 2.3 million American adults, or about 1.2 percent of the U.S. population age 18 and older in a given year.
    • Men and women are equally likely to develop bipolar disorder. The average age at onset for a first manic episode is the early 20s.

Suicide

  • In 2000, 29,350 people died by suicide in the U.S.
  • More than 90 percent of people who kill themselves have a diagnosable mental disorder, commonly a depressive disorder or a substance abuse disorder.
  • The highest suicide rates in the U.S. are found in white men over age 85.
  • In 2000, suicide was the 3rd leading cause of death among 15 to 24 year olds.
  • Four times as many men as women die by suicide; however, women attempt suicide 2-3 times as often as men.

Schizophrenia

  • Approximately 2.2 million American adults, 2 or about 1.1 percent of the population age 18 and older in a given year, 1 have schizophrenia.
  • Schizophrenia affects men and women with equal frequency.
  • Schizophrenia often first appears earlier in men, usually in their late teens or early 20s, than in women, who are generally affected in their 20s or early 30s.

Anxiety Disorders

  • Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).
  • Approximately 19.1 million American adults ages 18 to 54, or about 13.3 percent of people in this age group in a given year, have an anxiety disorder.
  • Anxiety disorders frequently co-occur with depressive disorders, eating disorders, or substance abuse.
  • Many people have more than one anxiety disorder.
  • Women are more likely than men to have an anxiety disorder.
  • Approximately twice as many women as men suffer from panic disorder, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia, and specific phobia, though about equal numbers of women and men have obsessive-compulsive disorder and social phobia.

    Panic Disorder

    • Approximately 2.4 million American adults ages 18 to 54, or about 1.7 percent of people in this age group in a given year, have panic disorder.
    • Panic disorder typically develops in late adolescence or early adulthood.
    • About 1 in 3 people with panic disorder develop agoraphobia, a condition in which they become afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.

    Obsessive-Compulsive Disorder (OCD)

    • Approximately 3.3 million American adults ages 18 to 54, or about 2.3 percent of people in this age group in a given year, have OCD.
    • The first symptoms of OCD often begin during childhood or adolescence.

    Post-Traumatic Stress Disorder (PTSD)

    • Approximately 5.2 million American adults ages 18 to 54, or about 3.6 percent of people in this age group in a given year, have PTSD.
    • PTSD can develop at any age, including childhood.
    • About 30 percent of Vietnam veterans experienced PTSD at some point after the war. The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

    Generalized Anxiety Disorder (GAD)

    • Approximately 4.0 million American adults ages 18 to 54, or about 2.8 percent of people in this age group in a given year, have GAD.
    • GAD can begin across the life cycle, though the risk is highest between childhood and middle age.

    Social Phobia

    • Approximately 5.3 million American adults ages 18 to 54, or about 3.7 percent of people in this age group in a given year, have social phobia.
    • Social phobia typically begins in childhood or adolescence.

    Agoraphobia and Specific Phobia

    • Agoraphobia involves intense fear and avoidance of any place or situation where escape might be difficult or help unavailable in the event of developing sudden panic-like symptoms.
    • Approximately 3.2 million American adults ages 18 to 54, or about 2.2 percent of people in this age group in a given year, have agoraphobia.
    • Specific phobia involves marked and persistent fear and avoidance of a specific object or situation. Approximately 6.3 million American adults ages 18 to 54, or about 4.4 percent of people in this age group in a given year, have some type of specific phobia.

Eating Disorders
  • The 3 main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
  • Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia 18 and an estimated 35 percent of those with binge-eating disorder 19 are male.
  • In their lifetime, an estimated 0.5 percent to 3.7 percent of females suffer from anorexia and an estimated 1.1 percent to 4.2 percent suffer from bulimia.
  • Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.
  • The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

Attention Deficit Hyperactivity Disorder (ADHD)

  • ADHD, one of the most common mental disorders in children and adolescents, affects an estimated 4.1 percent of youths ages 9 to 17 in a 6-month period.
  • About 2-3 times more boys than girls are affected.
  • ADHD usually becomes evident in preschool or early elementary years. The disorder frequently persists into adolescence and occasionally into adulthood.

Autism

  • Autism affects an estimated 1 to 2 per 1,000 people.
  • Autism and related disorders (also called autism spectrum disorders or pervasive developmental disorders) develop in childhood and generally are apparent by age 3.
  • Autism is about 4 times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.

Alzheimer's Disease

  • Alzheimer's disease, the most common cause of dementia among people age 65 and older, affects an estimated 4 million Americans.
  • As more and more Americans live longer, the number affected by Alzheimer's disease will continue to grow unless a cure or effective prevention is discovered.
  • The duration of illness, from onset of symptoms to death, averages 8 to 10 years.

Source: National Institute of Mental Health
NIH Publication No. 01-4584
Updated: January 1, 2001


Mental Health Disorders Morbidity

  • Percent of noninstitutionalized adults with severe psychological distress in the past 30 days: 3.0 (2002)

Health Care Use

Ambulatory care

  • Number of visits to office-based physicians for mental disorders: 44.8 million (2001)
  • Number of hospital emergency department visits for mental disorders: 2.2 million (2001)
  • Number of ambulatory care visits for mental disorders: 49.2 million (1997)
  • Number of ambulatory care visits for depression: 19.4 million (1997)
  • Number of ambulatory care visits for schizophrenia and other psychoses: 7.7 million (1997)
  • Number of ambulatory care visits for anxiety: 5.7 million (1997)
  • Number of ambulatory care visits related to drugs or alcohol: 3.6 million (1997)
  • Number of ambulatory care visits for attention deficit disorder: 3.5 million (1997)

Hospital inpatient care

  • Number of discharges for mental disorders: 2.4 million (2001)
  • Average length of stay for mental disorders: 7.4 days (2001)
2001 National Hospital Discharge Survey: Nursing home care
  • Number of residents with mental disorders, including Alzheimers disease, as primary diagnosis: 445,800 (1999)
  • Percent of residents with mental disorders, including Alzheimers disease, as primary diagnosis: 27.4 (1999)
  • Number of residents with Alzheimers disease and other dementias as primary diagnosis: 207,000 (1999)

Mortality

  • Number of suicide deaths: 30,622 (2001)
  • Suicide deaths per 100,000 resident population: 10.8 (2001)

Source:
National Center for Health Statistics
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Last Reviewed: December 09, 2003


Adults
The current prevalence estimate is that about 20 percent of the U.S. population are affected by mental disorders during a given year. This estimate comes from two epidemiologic surveys: the Epidemiologic Catchment Area (ECA) study of the early 1980s and the National Comorbidity Survey (NCS) of the early 1990s. Those surveys defined mental illness according to the prevailing editions of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-III and DSM-IIIR). The surveys estimate that during a 1-year period, 22 to 23 percent of the U.S. adult population—or 44 million people—have diagnosable mental disorders, according to reliable, established criteria. In general, 19 percent of the adult U.S. population have a mental disorder alone (in 1 year); 3 percent have both mental and addictive disorders; and 6 percent have addictive disorders alone.3 Consequently, about 28 to 30 percent of the population have either a mental or addictive disorder (Regier et al., 1993b; Kessler et al., 1994).

Individuals with co-occurring disorders (about 3 percent of the population in 1 year) are more likely to experience a chronic course and to utilize services than are those with either type of disorder alone. Clinicians, program developers, and policy makers need to be aware of these high rates of comorbidity--about 15 percent of those with a mental disorder in 1 year (Regier et al., 1993a; Kessler et al., 1996).

Based on data on functional impairment, it is estimated that 9 percent of all U.S. adults have the mental disorders listed in Table 2-6 and experience some significant functional impairment (National Advisory Mental Health Council [NAMHC], 1993). Most (7 percent of adults) have disorders that persist for at least 1 year (Regier et al., 1993b; Regier et al., in press). A subpopulation of 5.4 percent of adults is considered to have a "serious" mental illness (SMI) (Kessler et al., 1996). Serious mental illness is a term defined by Federal regulations that generally applies to mental disorders that interfere with some area of social functioning. About half of those with SMI (or 2.6 percent of all adults) were identified as being even more seriously affected, that is, by having "severe and persistent" mental illness (SPMI) (NAMHC, 1993; Kessler et al., 1996). This category includes schizophrenia, bipolar disorder, other severe forms of depression, panic disorder, and obsessive-compulsive disorder. These disorders and the problems faced by these special populations with SMI and SPMI are described further in subsequent chapters. Among those most severely disabled are the approximately 0.5 percent of the population who receive disability benefits for mental health-related reasons from the Social Security Administration (NAMHC, 1993).

Children and Adolescents
The annual prevalence of mental disorders in children and adolescents is not as well documented as that for adults. About 20 percent of children are estimated to have mental disorders with at least mild functional impairment (see Table 2-7). Federal regulations also define a sub-population of children and adolescents with more severe functional limitations, known as "serious emotional disturbance" (SED).4 Children and adolescents with SED number approximately 5 to 9 percent of children ages 9 to 17 (Friedman et al., 1996b).

Not all mental disorders identified in childhood and adolescence persist into adulthood, even though the prevalence of mental disorders in children and adolescents is about the same as that for adults (i.e., about 20 percent of each age population). While some disorders do continue into adulthood, a substantial fraction of children and adolescents recover or "grow out of" a disorder, whereas, a substantial fraction of adults develops mental disorders in adulthood. In short, the nature and distribution of mental disorders in young people are somewhat different from those of adults.

Older Adults
The annual prevalence of mental disorders among older adults (ages 55 years and older) is also not as well documented as that for younger adults. Estimates generated from the ECA survey indicate that 19.8 percent of the older adult population have a diagnosable mental disorder during a 1-year period. Almost 4 percent of older adults have SMI, and just under 1 percent has SPMI (Kessler et al., 1996); these figures do not include individuals with severe cognitive impairments such as Alzheimer's disease.

Costs of Mental Illness
The costs of mental illness are exceedingly high. Although the question of cost is discussed more fully in Chapter 6, a few of the central findings are presented here. The direct costs of mental health services in the United States in 1996 totaled $69.0 billion. This figure represents 7.3 percent of total health spending. An additional $17.7 billion was spent on Alzheimer's disease and $12.6 billion on substance abuse treatment. Direct costs correspond to spending for treatment and rehabilitation nationwide.

When economists calculate the costs of an illness, they also strive to identify indirect costs. Indirect costs can be defined in different ways, but here they refer to lost productivity at the workplace, school, and home due to premature death or disability. The indirect costs of mental illness were estimated in 1990 at $78.6 billion (Rice & Miller, 1996). More than 80 percent of these costs stemmed from disability rather than death because mortality from mental disorders is relatively low.

Source:
Mental Health: A Report of the Surgeon General 1999
U.S. Public Health Service


Other Mental Health Statistics

  • Preliminary studies indicate that 1 in 5 children/adolescents may have a diagnosable mental disorder.
  • An estimated 7.7 to 12.8 million children suffer from mental disorders (Center for Mental Health Services, 1993). These youth are estimated to have severe emotional or behavioral problems that significantly interfere with their daily functioning.
  • Nearly one-third of the nation's estimated 600,000 homeless individuals are believed to be adults with severe mental illnesses (CMHS, 1992).
  • More than 1 in 14 jail inmates has a mental illness.
  • Twenty-nine percent of the nation's jails routinely hold people with a mental illness without any criminal charges (National Alliance for the Mentally Ill and Public Citizens' Health Research Group).
  • More than 51 million Americans have a mental disorder in a single year (National Institute of Mental Health and CMHS, 1994).
  • During the course of any given year, while more than 40 million adult Americans are affected by one or more mental disorders, 5.5 million Americans are disabled by severe mental illnesses (NIMH, 1990).
  • An estimated 19.9 million Americans, 8.8 percent of the population, experience phobias. About 9.1 million, 5.1 percent of the population, live with major depression. Some 3.9 million have obsessive compulsive disorder; 2 million have schizophrenia; 2.4 million have panic disorder; 2 million experience bipolar disorders (NIMH, 1990).
  • At least two-thirds of elderly nursing home residents have a diagnosis of a mental disorder such as major depression (NIMH, 1990).
  • Up to 25 percent of the population with AIDS will develop AIDS- related cognitive dysfunction. Two-thirds of all people with AIDS will develop neuropsychiatric problems (Mental Health Liaison Group, 1993).
  • Mental disorders can be treated effectively if access to healthcare coverage and services is available for you and your family.

  • Depression
    • Can appear at any age and is one of the most common and treatable illnesses.
    • One in four women and one in 10 men can expect to develop depression during their lifetime.
    • Eighty to 90 percent of those who suffer from depression can be effectively treated and nearly all people who receive treatment derive some benefit.
  • Bipolar Disorder (manic-depressive illness)
    • Usually strikes before the age of 35 and will affect nearly 1 in 100 people.
    • Among the most treatable of the psychiatric illnesses and with the correct medication the number and intensity of episodes can be decreased for 70 percent of the people in treatment.
  • Panic Disorder (anxiety disorder class)
    • Will affect 1.3 percent of American adults each year.
    • Treatment consists of different medications and therapies with a 75 percent to 90 percent effectiveness.
  • Obsessive-Compulsive Disorder (OCD)
    • Will affect 2.1 percent of Americans and is one of the most complex of all mental disorders.
    • Although 75 percent of patients respond initially to treatment, most have a return of symptoms. However, nearly 80 percent of patients on a drug known as clomipramine showed some positive response and 60 percent experienced moderate response.
    • Combined behavioral and medical treatment offers new hope.

  • Lack of coverage puts you and your family at financial risk.
  • Most Americans do not have adequate coverage in the event of a mental health problem.
  • Annual out-of-pocket expenses for a serious mental disorder can cost tens of thousands of dollars under most current health care plans.
  • Direct costs--expenditures for professional healthcare for persons suffering form mental disorders, including care in mental specialty institutions, hospitals and nursing homes, physician and other professional services and prescription drugs--accounted for $67 billion, or 11.4 percent of all personal health care expenditures in 1990 (Rice and Miller, 1993).
  • Most healthcare plans cover mental disorders with significantly more restrictions on copayments and the type and amount of services covered.
  • Physical disorder coverage in the same healthcare plans typically covers from 70 percent to as high as 100 percent of costs, with no arbitrary limits to care.
  • Current Medicare and Medicaid coverage also is discriminatory in the same way.
  • According to the Bureau of Labor Statistics, 79 percent of employees in large and medium sized firms offering mental health benefits had more restrictive hospital coverage for mental illnesses than for other illnesses. Half of those employees had hospitalization limited to 30 to 60 days per year for mental illnesses, compared with 120 days or unlimited days for other medical illnesses.
  • Ninety-five percent of health insurance plans surveyed by the Bureau of Labor Statistics, limited out-patient coverage; 34 percent allowed fewer out-patient visits per year for mental health disorders than for other illnesses; 66 percent imposed special maximum dollar limits on out-patient visits for mental health services.
  • Many of those people whose need for care exceeds such limited insurance benefits frequently are transferred to state-run facilities.
  • Less than one-third of the children under 18 with a serious emotional disturbance receive mental health services. Often, the services they do receive are inappropriate (Children's Defense Fund, CMHS--Mental Health, U.S., 1994).
  • The mental health system relies on a high proportion for funds from public sources rather than private insurance and out-of-pocket payments. In 1990, 28 percent of funds for mental health care came from state and local governments. For physical healthcare, the comparable figure was 14 percent. Medicare, Medicaid, Veteran's Affairs and other Federal programs accounted for an additional 26 percent (National Mental Health Council).
  • Disparity (difference insurance companies have between physical coverage and mental health coverage) is a serious risk to those suffering mental illness.
  • Out of 50 states, only 2 - Maryland and Minnesota, have passed parity legislation stating that private insurance companies cannot discriminate on healthcare benefits.

Social Impact of Mental Disorders

Are You Covered?

  • A majority of the 29,000 Americans who commit suicide each year are believed to have a mental disorder. Suicide is the eighth leading cause of death in the U.S. and the third leading cause of death among people aged 15-24 (NIMH, 1994).
  • Mental illnesses impose a multibillion dollar burden on the economy each year. Total economic costs amounted to $147.8 billion in 1990. More than 31 percent of those costs -- $46.6 billion - are for anxiety disorders (the Economic Burden of Affective Disorders, Dorothy P. Rice, Ph.D., and Leonard S. Miller, Ph.D., 1993).
  • Three independent studies between 1971 and 1985 found that mental health costs remained relatively constant during the past 20 years, ranging from 9 to 11 percent of the direct treatment costs for healthcare (Bazelon Center for Mental Health Law, 1993).
  • Direct treatment and support costs comprise 45.3 percent of the total economic costs of mental disorders. The value of reduced or lost productivity comprise 42.7 percent of the total economic costs of mental disorders. Mortality costs compromise 8 percent and other related costs, including expenditures on criminal justice, the value of lost time due to incarceration and an imputed value for caregiver services, comprise 4 percent (Rice and Miller, 1993).
  • Morbidity costs -- the value of goods and services not produced because of health problems -- amounted to $63.1 billion for all mental disorders in 1990. Morbidity costs for anxiety disorders accounted for $34.2 Billion; for schizophrenia, $10.7 billion. The morbidity costs for anxiety disorders reflect their prevalence in the population and the high rate of lost productivity (Rice and Miller, 1993).
  • Mortality costs -- the current value of lifetime earnings lost by all who died in 1990 because of mental disorders -- amounted to $11.8 billion in 1990 (Rice and Miller, 1993).
  • Other related costs - the costs indirectly related to the treatment and lost productivity of people with mental disorders -- amounted to $6 billion in 1990 (Rice and Miller, 1993).

    Source: National Mental Health Association