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Sunday, April 26, 2009

Help! There's an Epidemic of Anxiety! (Part I)

All British journalists are psychotic. Pathologically obsessed with "mental health issues", and suffering from grandiose delusions of their competence to discuss them, these demented maniacs...

Sorry. I got a bit carried away there. But you'll forgive me, because I was just following the example of seemingly everyone in the British media these past couple of weeks. If you believe the headlines, we're in the grip of an epidemic of anxiety:

BBC: UK society 'increasingly fearful'
The Telegraph: Britons 'living in fear' as record numbers suffer from anxiety

The Independent: Britain is becoming a more fearful place – and the economy is paying the price. The Indie also ran a comment by Janet Street-Porter - "The main reason people feel anxious is loneliness.", thanks Janet, qualifications: none, career path: fashion journalist - and a piece by a clinically anxious person - "I reckon a root cause of my anxiety is the modern notion that we can do away with risk by anticipating every imaginable danger."
It all started with a report by the Mental Health Foundation called In The Face Of Fear. The Mental Health Foundation are a perfectly decent charity organization, although they have a prior history of endorsing slightly dodgy research. One of their previous reports, Feeding Minds: The Impact of Food on Mental Health, presented a simplistic and overblown account of the effects of nutrition upon mood and drew heavily on the "work" of Patrick Holford, vitamin pill peddler and well-documented crank. Parts of the present report are, unfortunately, dodgy as well, as you'll see below.

In The Face of Fear is actually quite thought-provoking piece of writing, but you wouldn't know that from reading the newspapers. The headlines are all about the supposed surge in anxiety amongst the British population. This, however, is the dodgiest part of the report. Firstly, the report's authors surveyed 2246 British adults in January 2009. 37% said that they get frightened or anxious more often than they used to, 28% disagreed, and 33% neither agreed nor disagreed.

That's it. That's the finding. It's really not very impressive, because quite apart from anything else, it relies upon the respondent's ability to remember how anxious they were in the past. You just can't trust people to do hard stuff like that. I know exactly what I'm worried about today - I can't remember very well what I worried about ten years ago - so I must be more worried today! Of course, this could also work in reverse, and people might forget their past lack of anxiety and wrongly say that they are less anxious today.

The survey also found that 77% of people said that "people in general" are more anxious than they used to be, while just 3% disagreed. But remember that only (at most) 37 out of those 77% said that they themselves were actually more anxious. Hmm. So the real finding here seems to be that there is a widespread perception that other people are becoming more anxious, though it's anyone's guess whether this is in fact true. The report itself does note that
more than twice as many of us agree that people in general and the world itself are becoming more frightened and frightening as agree that they themselves are more frightened and anxious
This was rather too subtle for the newspapers, though, who reported... that people are becoming more anxious.

In The Face of Fear also cites a government study on the mental health of the British population, the Adult Psychiatric Morbidity Survey. Their use of this data, however, is selective to the point of being deception. This was a household survey of a weighted sample of the British population. That section of the population who live in houses and don't mind being interviewed about their mental health, that is. Diagnoses were made on the basis of the CIS-R interview, which scores each person on a number of symptoms (including "worry", "fatigue", and "depressive ideas"). Each person is then given a total score; a total score of 12 or more is (arbitrarily) designated to indicate a "neurotic disorder".

This was done in 1993, 2000 and 2007. The 2007 report notes that overall, levels of neurotic disorders increased between 1993 and 2000, but then stayed level in 2007. In terms of anxiety disorders, there was a very small increase in "generalized anxiety disorder" (from 4.4% to 4.7%), which mostly happened between 1993 and 2000; there was an increase in phobias, from 1993 2.2% to 2007 2.6%, but rates peaked at 2.8% in 2000; and "mixed anxiety and depressive disorder" increased from 7.5% in 1993 to 9.4% in 2000 to 9.7% in 2007.

What to make of that? It's hard to know, but it's clear that any worsening in anxiety levels occured some time between 1993 and 2000. Mysteriously, while the Mental Health Foundation report cites the 1993 and the 2007 figures, and makes much of the increase, it simply ignores and does not mention the 2000 figures, which show that any increase has long since stopped. It's history, not current events. Back in 2000, you might recall, the twin towers were still standing, The Simpsons was still funny, and Who Let The Dogs Out was top of the charts.

Overall, the evidence that people in Britian are actually feeling more and more anxious is extremely thin. In fact, I would say that it's a myth. It's a very popular myth, however: 77% of the population believe it. Why? Well, the fact that the Mental Health Foundation seem determined to make the data fit that story can't be helping matters. The newspapers, not to be outdone, focussed entirely on the scariest and most pesimissitic aspects of the report.

A poor show all round, but - as always on Neuroskeptic - there are some important lessons here about how we think about threats, social change, and "crisis". Stay tuned for the good stuff next post.

[BPSDB]

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