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Saturday, December 12, 2009

That Sinking Feeling?

Sinking and Swimming is a paper just out from the Young Foundation, a British think-tank. It "explores how psychological and material needs are being met and unmet in Britain." I'm not sure how useful their broad concept of "unmet needs" is, but there's some rather interesting data in this report.

On page 238, and prominently in the executive summary, we find the following terrifying graph, which comes with warnings like "anxiety and depression looks set to double during the course of a single generation..."

The % of the population self-reporting suffering from depression or anxiety seems to have been consistently rising since 1990, from less than 6% to almost 10% today. And the line continues ever upwards. Eeek!

Is Britain really becoming more depressed and anxious? No, and that's what makes this graph terrifying. According to the large government Adult Psychiatric Morbidity Survey, the prevalence of self-reported depression and anxiety symptoms rose slightly from 1993 to 2000 (15.5% to 17.5%) and then stayed level up to 2007 (17.6%). Not very scary. Even the Young Foundation note (on page 80) that when you look at "well-being"
analysis of the English health survey that uses a variation of GHQ [General Health Questionnaire] suggested that the proportion of the working age population with poor psychological well-being decreased from 17% in 1997 to 13% in 2006.
On that measure, we're getting happier. And the rate of new diagnoses of clinical depression fell over the past decade.

So what about that ominous line? Well, that graph was based on "self-reported anxiety or depression", but in a specific sense. People were not reporting feeling scared or unhappy (see above for the data on that), but rather, reporting having anxiety or depression as medical disorders. Curiously the % of people reporting having every other sort of health problems (except with vision) increased from 1991 to 2007 as well:


What seems to be happening is that British people are becoming more willing to label our problems as medical illnesses, although in fact our mental health has not changed much over the past two decades, and may even have improved slightly. This is what's terrifying, because medicalizing emotional issues is a bad idea.

Mental illness does exist, and medicine can help treat it, but medicine can't resolve non-medical problems even if they're labelled as illnesses. Antidepressants, for example, are (imperfectly) effective for severe clinical depression but probably not for "mild depression"; much of what is labelled "mild depression" is probably not, in any meaningful sense, an illness.

Why does this matter? Drugs have side effects, and psychotherapy is expensive. The cost-benefit profile of any treatment is obviously negative when there are no benefits because the treatment is being used inappropriately. My biggest concern, though, is that if someone is unhappy because of tensions in their marriage or because they're in the wrong job, they don't need treatment, they need to do something about it. Labelling a problem as an illness and treating it medically may, in itself, make that problem harder to overcome.

[BPSDB]

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