Prevalence and Treatment of Mental Disorders, 1990 to 2003
Ronald C. Kessler, Ph.D., Olga Demler, M.A., M.S., Richard G. Frank, Ph.D., Mark Olfson, M.D., Harold Alan Pincus, M.D., Ellen E. Walters, M.S., Philip Wang, M.D., Dr.P.H., Kenneth B. Wells, M.D., and Alan M. Zaslavsky, Ph.D.
Background Although the 1990s saw enormous change in the mentalhealth care system in the United States, little is known aboutchanges in the prevalence or rate of treatment of mental disorders.
Methods We examined trends in the prevalence and rate of treatmentof mental disorders among people 18 to 54 years of age duringroughly the past decade. Data from the National ComorbiditySurvey (NCS) were obtained in 5388 face-to-face household interviewsconducted between 1990 and 1992, and data from the NCS Replicationwere obtained in 4319 interviews conducted between 2001 and2003. Anxiety disorders, mood disorders, and substance-abusedisorders that were present during the 12 months before theinterview were diagnosed with the use of the American PsychiatricAssociation's Diagnostic and Statistical Manual of Mental Disorders,fourth edition (DSM-IV). Treatment for emotional disorders wascategorized according to the sector of mental health services:psychiatry services, other mental health services, general medicalservices, human services, and complementary–alternativemedical services.
Results The prevalence of mental disorders did not change duringthe decade (29.4 percent between 1990 and 1992 and 30.5 percentbetween 2001 and 2003, P=0.52), but the rate of treatment increased.Among patients with a disorder, 20.3 percent received treatmentbetween 1990 and 1992 and 32.9 percent received treatment between2001 and 2003 (P<0.001). Overall, 12.2 percent of the population18 to 54 years of age received treatment for emotional disordersbetween 1990 and 1992 and 20.1 percent between 2001 and 2003(P<0.001). Only about half those who received treatment haddisorders that met diagnostic criteria for a mental disorder.Significant increases in the rate of treatment (49.0 percentbetween 1990 and 1992 and 49.9 percent between 2001 and 2003)were limited to the sectors of general medical services (2.59times as high in 2001 to 2003 as in 1990 to 1992), psychiatryservices (2.17 times as high), and other mental health services(1.59 times as high) and were independent of the severity ofthe disorder and of the sociodemographic characteristics ofthe respondents.
Conclusions Despite an increase in the rate of treatment, mostpatients with a mental disorder did not receive treatment. Continuedefforts are needed to obtain data on the effectiveness of treatmentin order to increase the use of effective treatments.
Source Information
From the Department of Health Care Policy, Harvard Medical School, Boston (R.C.K., O.D., R.G.F., E.E.W., P.W., A.M.Z.); the New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (M.O.); RAND and the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (H.A.P.); the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston (P.W.); and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (K.B.W.).
Address reprint requests to Dr. Kessler at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at kessler{at}hcp.med.harvard.edu.
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