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How to write a great review. The review must be at least 50 characters long. The title should be at least 4 characters long. Your display name should be at least 2 characters long. At Kobo, we try to ensure that published reviews do not contain rude or profane language, spoilers, or any of our reviewer's personal information. In contrast to the symbolic-interactionist emphasis on the fluidity of social interaction, Goffman's is a portrait of structural determinism.

Mental hospitals resemble prisons and concentration camps as well as monasteries, nunneries, and boarding schools. Life in such places is a product of their structural features, and their defects are not removable by any conceivable sets of reforms. Instead, life in a mental hospital inexorably tends to damage, dehumanize, and destroy. From the late s through the s, the intellectual distance and even hostility between sociologists and psychiatrists often seemed to be growing.

Within five years of the appearance of Asylums , the California sociologist Thomas Scheff had authored an in some ways still more radical assault on psychiatry, dismissing the medical model of mental illness and attempting to replace it with a societal reaction model, wherein mental patients were portrayed as victims—victims, most obviously, of psychiatrists Scheff During the s and s, the societal reaction theory of deviance enjoyed a broad popularity and acceptance among many sociologists, and Scheff's was one of the principal works in that tradition.

But besides attracting derision and hostility from psychiatrists M. Roth , where [Page xxxii] they deigned to notice his work at all, it came under increasing criticism from within sociology on both theoretical D. Morgan and empirical W. Gove ; Gove and P. In the face of an avalanche of well-founded objections, Scheff was eventually forced to back away from many of his more extreme positions, and by the time the third edition of his book appeared Scheff , most of its bolder ideas had been quietly abandoned.

Labeling and stigmatization of the mentally ill have remained important subjects for sociologists, even if few would now argue that they have the etiological significance once attributed to them. Though the skeptical claims of the labeling theorists have now been sharply curtailed, much of the sociological work being done on mental illness has retained its critical edge. Four major interrelated changes have occurred in the psychiatric sector in the past half-century or so: Sociologists have played a crucial role in analyzing the sources and impact of most of these changes, and sociological perspectives have spread and been highly influential among others attempting to make sense of these profoundly important developments.

Deinstitutionalization, for example, was initially presented as a grand reform, ironically just as the mental hospital had originally been D. Rothman ; Scull , From the mids, however, a more skeptical set of perspectives emerged. Psychiatrists had assumed that the new generation of antipsychotic drugs had been the main drivers of the expulsion of state hospital patients.

A series of studies demonstrated the fallacy of this claim Scull , ; P. Others sought alternative explanations of the shift in social policy, and a series of studies began to suggest some of the defects of the new approach to the management of chronic mental illness S. Scully ; Scull , ; S. Rose ; Gronfein b. The hegemony of the DSM began to attract attention, with critics examining both the processes by which the successive editions had been produced and the intended and unintended effects of its widespread use Kirk and H.

Kutchins ; Kutchins and Kirk ; A. The sources and impact of the psychopharmacological revolution drew increased interest, with attention paid to both the role of the pharmaceutical industry and changes in the intellectual orientation of the psychiatric profession D. Healy , ; D. All of this occurred in a context where much of the federal money that had once underwritten sociological work on mental illness had been sharply curtailed. In the s and s, NIMH continued to broadly define its research mission and fund an extensive array of psychological and sociological research.

Subjected to political pressures to direct funding toward the solution of social problems, the agency underwrote a broad array of studies on such topics as crime, drug and alcohol addiction, suicide, and even rape—all topics of some relevance to mental health issues and all ensuring a continual flow of federal research money into the social sciences, but scarcely central concerns for those focused on psychiatric disorders.

During the s, however, this pattern of research funding abruptly altered. The Republican administration elected in ordered NIMH to redirect its funding priorities away from social problem—oriented research toward work more directly pertinent to the understanding of mental disorders L. Simultaneously, the intellectual center of gravity within psychiatry was shifting decisively away from psychoanalysis and a biosocial model of mental disorder and toward a biologically reductionist view of mental illness.

The social, so far as most psychiatrists were concerned, went from being directly relevant to being at best marginal to their research. Thus, political pressures to avoid controversial and sensitive [Page xxxiii] work on the sociological dimensions of mental disorder were reinforced by the demands of psychiatry for an increased focus on neuroscience and psychopharmacological research. Scholars working on the sociology of mental illness thus now confront a very different research environment than the one that prevailed a quarter century ago. The range of intellectual and policy issues thrown up by the dramatic changes that have marked the mental health sector in the same period mean, however, that there is an abundance of challenging topics for the study of which sociological perspectives are indispensable.

The range and scope of this encyclopedia create a vivid testimony to the intellectual vitality of the field and will hopefully make a useful contribution to the next generation of sociological research on the cultural sociology of mental illness. In England, the Act De Praerogative Regis gives the king custody of the lands and property of the mentally incapable; it also gives officers of the king, known as escheators, the right to hold inquisitions to determine the mental competency of individuals.

Mary of Bethlehem; this institution gives rise to the term bedlam for an institution housing the mentally ill. The German physician Paracelsus Phillipus Aureolus Theophratus Bombastus von Hohenheim writes a book, Diseases Which Lead to a Loss of Reason , describing mental illness as caused by physical diseases rather than supernatural causes; it is published in With All the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of It , a collection of opinions from various authors on melancholia depression.

The first edition is almost pages and includes poetry and historical accounts as well as excerpts from medical and scientific authorities. Dorothea Dix, an American schoolteacher, begins her crusade to improve conditions for the mentally ill after observing insane people being held in inhumane conditions in a jail. One measure of her success is that she succeeded in getting 32 U. The Scottish craftsman Daniel M'Naghten, believing that his life is in danger, attempts to kill British prime minister Robert Peel but instead shoots and kills Peel's secretary, Edward Drummond.

In response to this case, a panel of British judges develop what is known as the M'Naghten Rules, a series of questions to determine if a person is legally insane. The Association of Medical Superintendents of American Institutions for the Insane is founded in Philadelphia by superintendents from 13 of the 24 mental hospitals existing in the United States. The purposes of the association include professional study, communication, and assistance to improve the treatment of the insane.

Patients at the Utica State Lunatic Asylum in New York State begin publishing a monthly newsletter, The Opal , including poems, essays, and reflections written by the patients. Proceeds from the sale of The Opal are used to buy books for the patients' library. The Swedish scientist Magnus Huss coins the term alcoholism , which he describes as an abusive level of alcohol consumption that he labels alkoholismus chronicus. It has 1, beds, a contradiction to the recommendation of the Association of Medical Superintendents of American Institutions for the Insane that mental hospitals should contain no more than beds.

By the midth century, some state hospitals contain as many as 10, beds. A report from Surgeon-Major R. The asylums were founded after the British established their rule in and segregated patients by origin—Europeans were treated in modern private asylums, while Indians were housed in poorly maintained public institutions.

The German neurologist Otto Westphal introduces the term agoraphobia in a paper describing three male patients who suffer from a dread or fear of public places. Westphal also remarks that the patients could be distressed simply by thinking of a feared situation without actually being in it. In British Columbia, Canada, the first insane asylum is established by the Royal Hospital in a cottage previously used for quarantined patients.

It is closed in and the patients moved to a newly built asylum in New Westminster. The American physician George Miller Beard publishes Cases of Hysteria, Neurasthenia, Spinal Irritation, or Allied Affections , in which he describes a new disease, neurasthenia, which he believes is caused by an oversupply of nervous energy due to the demands of modern life.

At the University of Leipzig, the German physician Wilhelm Wundt establishes the world's first experimental laboratory for psychological research; for this reason, Wundt is often cited as the father of experimental psychology. Written partly in Latin, this book describes many sexual disorders, including sadism and masochism, and was also one of the first books to discuss homosexuality and bisexuality.

His concepts continue to support eugenic ideas up to his death in and into the s. The German psychiatrist Emil Kraepelin publishes Compendium der Psychiatrie , the basis for the modern system of classifying mental disorders. It calls for expanded study of mental disorders, including research into their physical causes, and case studies to clarify their typical progression.

The French physician Jacques Bertillon introduces the Bertillon Classification of Causes of Death , which is widely adopted in other countries. It forms the basis of the International Classification of Diseases system now used by the World Health Organization and many other organizations. Their Psychical Mechanism and Their Aetiology. In the book, he distinguishes between phobias and obsessions by noting that while various emotions are involved in obsession, phobias are always accompanied by a state of anxiety.

The Russian neurologist Sergei Korsakoff describes a syndrome seen in some long-term alcoholics as well as in some individuals with head injuries, brain tumors, or poisoning. Symptoms of Korsakoff's syndrome include disorientation, loss of memory, and confabulation making up stories. The Austrian physician Sigmund Freud publishes The Interpretation of Dreams , introducing key concepts of psychoanalysis such as the Oedipus complex and the revelation of the unconscious through dreams. An edited version of these lectures is published as The Variety of Religious Experience: A Study in Human Experience in The French psychologist Pierre Janet classifies neurotic disorders as either hysteria disturbances in consciousness, sensation, and movement or psychasthenia including depression, obsessions, phobias, and anxiety.

In the course of his research on digestion at the Institute of Experimental Medicine, Pavlov discovered the principle of operant conditioning and of conditioned reflexes. The German psychiatrist Alois Alzheimer performs an autopsy on a patient who had suffered from short-term memory loss and other symptoms, and identifies within this patient's brain the characteristic neurofibrillary tangles and amyloid plaques now identified with Alzheimer's disease.

The publication of A Mind That Found Itself , the autobiography of Clifford Beers, describes the poor conditions in mental asylums [Page xxxviii] in the United States and leads to the founding of the advocacy group called the National Committee for Mental Hygiene. The Swiss psychiatrist Eugene Bleuler coins the term schizophrenia , derived from the Latin roots schizo split and phrenia mind to replace Emil Kraepelin's term for the same condition, dementia praecox.

The cause is believed to be shocks delivered to the nervous system. By , 5 percent of hospital beds are reserved for patients with hysteria. The psychologist Lewis Terman, working at Stanford University, publishes a revised version of an intelligence test originally created in by the French psychologist Alfred Binet and the French physician Alfred Simon.

The Stanford-Binet Intelligence Scales compare a child's performance with that expected of children of the same age, an approach still used in contemporary intelligence testing. The Austrian psychiatrist Julius Wagner-Hauregg begins investigating the benefits of induced fevers in mental patients and produces these fevers by inoculating the patients with blood infected with malaria. Wagner-Hauregg was awarded the Nobel Prize for Physiology or Medicine in , and induced fever by malaria continued to be used to treat mental patients until approximately The Personal Data Sheet, a brief, self-reporting questionnaire about symptoms such as sleepwalking and suicidal thoughts, proves remarkably successful in separating mentally disturbed individuals from those functioning normally.

The Provincial Mental Home for the Criminally Insane opens with just nine patients but houses 99 by the end of the year. The American psychiatrist Edward Kemp coins the term homosexual panic to refer to the fear that one will be sexually assaulted by a member of one's own sex, or the fear that one may in fact be homosexual. Homosexual panic is sometimes cited as a cause for attacks on gay men, suggesting that the attacker is responding to an imagined threat caused by their discomfort with homosexuality.

It becomes a standard textbook in Germany, and Lenz later helps to draft the Nazi government's sterilization law. Although the original purpose for having the patients work is to overcome a staff shortage, it proves so beneficial that when Simon becomes director of a different psychiatric facility, he has almost 90 percent of the patients doing some kind of work as part of their treatment.

The American physician John Mayo Berkman publishes the first large-scale report on patients with anorexia. He discusses patients treated over a period of 10 years and is often credited with bringing anorexia back into the consciousness of modern medicine. In the United States, the creation of the Mental Hygiene Division within the Public Health [Page xxxix] Service is originally concerned with operating two hospitals dedicated to treating addictions but also acts as a forerunner of the National Institute for Mental Health.

The German neurologist Johannes Heinrich Schultz develops the technique of autogenic training to treat high blood pressure. Autogenic training is now used for stress relief and the treatment of sleep disorders and many other conditions. In autogenic training, the patient learns to achieve relaxation and induce a state similar to hypnosis.

The Austrian psychiatrist Manfred Sakel begins administering insulin shock therapy to mental patients. In the procedure, the patient receives progressive doses of insulin until they go into a coma, then receives a sugar solution to restore consciousness. By , almost three-quarters 71 percent of American psychiatric facilities are using insulin shock therapy. About six months after Adolf Hitler is named chancellor of Germany and the Nazi Party forms a governing coalition, Germany passes the Law for the Prevention of Hereditarily Ill Offspring, providing for sterilization of those considered to have hereditary diseases, including the insane.

William Griffith Wilson and Dr. AA is a self-help organization for alcoholics, with the goal of helping them achieve and maintain sobriety. The German psychiatrist Franz Kallman, working in the United States, is the first to suggest that there may be a genetic component to schizophrenia.

Cultural Sociology of Mental Illness: An A-to-Z Guide

He establishes the first full-time genetics department in a U. In Canada, the Opium and Narcotics Act is amended to define codeine as a substance prohibited except when used by a physician to treat disorders other than addiction. Codeine was first regulated in Canada in but was deregulated in Known within AA as the Big Book, this volume was the first published statement of the Twelve-Step Method used in Alcoholics Anonymous to help alcoholics achieve and maintain sobriety.

Lee Faris and Warren H. Dunham publish Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses , an early example of a study linking socioeconomic status with mental health. In looking at residents of Chicago, Faris and Dunham find a strong relationship between the stressful conditions present in certain neighborhoods and mental illness in individuals. The original MMPI requires individuals to agree or disagree with statements and assesses them on nine personality scales: At about the same time, the Austrian pediatrician Hans Asperger identifies a similar syndrome in a group of child patients.

One distinction between Kanner's and Asperger's subjects is that all of Asperger's subjects are able to speak; hence, the term Asperger's syndrome is usually applied to autistic individuals with normal language development. The American psychologist B. Skinner publishes Walden Two , a novel describing a fictional utopian community whose members adopt an experimental approach to all aspects of their life. Walden Two expresses Skinner's beliefs that free will does not exist and that human behavior is governed by a combination of genetics and environment.

Journalist Albert Deutsch publishes Shame of the States , exposing the terrible conditions in state mental hospitals, which at the time are housing many mentally ill people. This report is influential in the deinstitutionalization movement in the United States. This volume includes the Kinsey Scale, which ranks the sexuality of men from 0 completely heterosexual to 6 completely homosexual , as well as the conclusion that 10 percent of men were primary homosexual for at least three years of their adult life.

Kinsey's results have since been criticized on many grounds, including the selection of his sample, but are groundbreaking in terms of presenting objective data about the sexual practices of Americans. John Frederick Joseph Cade, an Australian psychiatrist, first uses lithium to treat psychosis. It becomes a standard treatment, replacing barbiturates and bromides, to treat manic depressive bipolar disease.

The German American psychoanalyst and psychologist Erik Erikson publishes his book Childhood and Society , popularizing the term identity crisis and developing Freud's concept of infantile sexuality. In France, the antipsychotic drug chlorpromazine Thorazine is first used to successfully treat psychosis. This and other antipsychotics provide breakthrough treatment for schizophrenia, with an estimated 70 percent of patients helped by antipsychotic drug therapy. This classification of mental disorders becomes highly influential among mental health professionals.

It has since been revised regularly, with the fifth edition published in Hollingshead and Frederick C. Skinner publishes Science and Human Behavior , which includes a description of his theory of operant conditioning. Congress regarding creation of a national mental health program. The introduction of psychoactive drugs in the United States coincides with the beginning of a rapid decline in the number of mentally ill people held in mental hospitals. Some contend that it also helps speed the deinstitutionalization process by allowing some people with serious mental illness to function in assisted living facilities or with support from community mental health organizations.

In this book, Selye explains his theory of general adaptation syndrome, which describes how stress affects mental and physical well-being. This decision influences many areas of life, including insurance coverage for alcohol-related conditions and the legal status of alcoholics. The American psychologist Leon Festinger publishes his theory of cognitive dissonance, which describes how people behave when they experience a conflict among their beliefs, behaviors, and attitudes. Festinger argues that people are uncomfortable with cognitive dissonance and may change their attitudes to match their behavior.

The South African physician Joseph Wolpe, working in the United States, publishes reports of his use of systematic desensitization to treat adults. The technique, which involves training a patient in relaxation techniques and then introducing a feared stimulus or having the person imagine a feared situation, works on the principle that a person cannot be anxious and relaxed at the same time.

In his doctoral dissertation at the University of Chicago, the American psychologist Lawrence Kohlberg outlines his theory of the stages of moral development. Inspired by the work of Swiss developmental psychologist Jean Piaget, this theory suggests that as children mature, they are able to engage in more complex moral reasoning. Kohlberg's theory becomes extremely influential but is also criticized on the grounds that it emphasizes a male, Western point of view and values justice to the exclusion of other important values such as caring for others.

The first methadone treatment program is established in British Columbia, Canada. Robert Halliday, the program does not have the goal of abstinence but of maintenance; Halliday likens the program to insulin treatment for diabetics. Byrne studies patients in mental hospitals in Africa, Latin America, and the United States and concludes that the major mental illnesses such as schizophrenia manifest themselves in the same way in widely different cultures.

Their Development and Change , arguing that public education [Page xlii] is necessary to overcome the stigma of mental illness. Kesey's best-selling novel is based on the antipsychiatry position that mental patients are simply nonconformists rather than people with genuine illnesses. In October, the U. Congress passes the Community Mental Health Centers Act, authorizing federal funds to create mental health centers in local communities to care for new mental health patients as well as individuals formerly housed in state mental hospitals. Michel Foucault's Madness and Civilization: American sociologist Thomas J.

Scheff publishes Being Mentally Ill: A Sociological Theory , articulating his theory that labeling deviant behavior as signs or results of mental illness stigmatizes individuals who display such behavior, with potentially profound effects such as the adoption of mental illness as part of the self-image. The concept of brain death, which allows a physician to certify a patient as dead even if their heart and lungs may continue to function with the assistance of life-support equipment, remains controversial but has been adopted by some countries and some U.

Holmes and Richard H. This scale assigns a numerical value to different life events for instance, for the death of a spouse, 45 for retirement, 20 for change in residence or school and instructs individuals to calculate their score by adding up the points for all the events that have happened to them in the past year. A higher score indicates greater stress and increased probability of illness in the upcoming year; for instance, a score between and predicts a 51 percent increase in the probability of illness.

Partly as a result of this action, homosexuality is no longer listed as a disease in the printing of DSM-II. The American psychiatrist Aaron T. The American cardiologist Dr. Herbert Benson publishes The Relaxation Response , describing [Page xliii] the physiological response some people experience as a result of transcendental meditation. Benson writes that this response can help people manage conditions such as high blood pressure, although he cautions that it is not a substitute for medical care and appropriate use of medication.

The film wins five Oscars, including Best Picture, and helps to popularize the antipsychiatry position that people in mental hospitals are nonconformists who are inconvenient to society, rather than people needing treatment for illnesses. He claims that he was able to improve his condition by ending medical treatment, taking large doses of vitamin C, and watching humorous movies in a comfortable hotel room rather than the hospital.

His case history is groundbreaking in its approach to the patient taking charge of their own health, sparking the trend of patients working with their doctors and using humor for healing. At its annual meeting, the World Psychiatric Association WPA issues a proclamation condemning the use of psychiatric institutionalization of political dissidents in the Soviet Union. The WPA also issues a code of ethics called the Declaration of Hawaii, which specifies, among other things, that patients must be informed of treatment options and must consent to treatment unless they lack the capacity to reason.

Edna Rawlings and Dianne Carter publish Psychotherapy for Women , a book claiming that social and external causes, rather than internal and personal forces, are behind many women's psychological problems and that society should become more just rather than expecting women to cheerfully adapt to the unjust state of society. The National Alliance for the Mentally Ill, a grassroots advocacy and support organization for people with mental illness, is founded in the United States.

It is the largest and most comprehensive survey of its type, conducted to determine the overall prevalence of mental disorders—not just among those who sought treatment—and the need for mental health services. The American singer Karen Carpenter dies of cardiomyopathy at age 32 after years of suffering from anorexia and bulimia and abusing syrup of ipecac to induce vomiting. Her death brings great publicity to the risks of anorexia and bulimia, particularly for young women. Marti Loring and Brian Powell publish an article in the Journal of Health and Social Behavior that casts doubt on the objectivity of the psychiatric diagnosis process.

After sending the description of symptoms to different psychiatrists, along with varying gender and racial characteristics, they find that the diagnoses vary by the gender and race of the hypothetical patient as well as the gender and race of the psychiatrist making the diagnosis. These findings are later applied to workers in other countries, with the general conclusion that workers who experience high levels of stress from high work demands, coupled with low levels of control and low social support, are at increased risk for many diseases and behaviors such as drug and alcohol abuse.

Clayson and Michael L. Klassen release the results of a study demonstrating that many Caucasian American college students hold negative views of obese people, associating them with characteristics such as lazy, unhealthy, insecure, and lacking in self-discipline. Department of Veteran's Affairs creates the National Center for Posttraumatic Stress Disorder to treat military veterans with post-traumatic stress disorder PTSD and to advance research and clinical practice for individuals suffering from this condition. John Mirowsky and Catherine E. Ross publish an article in the Journal of Health and Social Behavior estimating that social conditions are a primary influence in depression.

According to their research, half of depressive symptoms could be explained by social conditions, and an even higher proportion almost three-quarters of those symptoms could be explained by positions of low personal control and social position. The passage of the Americans with Disabilities Act prohibits discrimination against the disabled in employment. C-CAR works to facilitate research and the exchange of knowledge on children and young people with developmental, emotional, and brain disorders.

Based on interviews with almost 20, adults, the ECA is able to provide estimates of the incidence and prevalence of mental disorders, whether or not sufferers have sought treatment. The book helps to popularize mindfulness meditation, a type of meditation drawing on Buddhist traditions, to reduce stress and induce relaxation, with claims that it also helps treat physical disorders. The Alzheimer's diagnosis of former U. This announcement brings heightened awareness of the disease as well as speculation about how long Reagan might have been suffering from it.

Results from the National Comorbidity Study, the first study in the United States to estimate the prevalence of psychiatric disorders using a national probability sample, is published. One of the striking findings is the strong relationship between socioeconomic status SES and psychiatric disorders. Lower SES is associated with higher probability of psychiatric disorder. A study from the Chinese University of Hong Kong reports that eating disorders and body dissatisfaction have become common among Chinese adolescent girls, suggesting that this is due to the increasing influence of Western cultures.

The MHPA requires that group insurance plans covering more than 50 workers provide annual and lifetime medical benefits limits for mental health at least as high as those provided for medical and surgical benefits. This is a surprising result because it is generally believed that deinstitutionalization and community mental health treatment would have reduced the stigma associated with mental illness.

In Canada, constable Gil Puder, speaking at the Fraser Institute Forum, calls for an end to the Canadian War on Drugs and the creation of a harm reduction program in its place. They also report that, contrary to popular belief, rapid switching between tasks may not be efficient because people lose significant amounts of time as they switch from one task to another and that this loss of time increases with the complexity of the tasks performed.

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According to the report, about million people around the world suffer from a mental disorder and 25 percent will be affected by a mental disorder at some point in his or her life. In Vancouver, British Columbia, the North American Opiate Medication Initiative clinical trials test whether people who are suffering from chronic opiate addictions and have not been helped by other treatments might be aided by heroin-assisted therapy.

A report by the American Psychoanalytic Association finds that while psychoanalysis is frequently discussed in U. A bill decriminalizing adult use of marijuana is introduced in the U. Congress but does not pass. It is reintroduced in but, again, it does not pass. The CDC also reports that several studies found a link between blood lead levels and symptoms of hyperactivity and impulsivity.

Cook of the College of Education at the University of Washington and colleagues from the University of California, Riverside publish a literature review in School Psychology Quarterly showing that poor academic performance and poor problem-solving skills are highly predictive of which children would engage in bullying behavior. Psychologist Scott Huetell and colleagues publish a report in Psychology and Aging showing that, after controlling for cognitive abilities such as memory, the tendency to make risky decisions does not increase with age, contrary to popular belief.

The New York Times reports that many U. A study by Aaron T. Beck and colleagues, published in the Archives of General Psychiatry , finds that patients with severe schizophrenia respond well to a type of cognitive behavior therapy originally developed to treat depression. A report from the Substance Abuse and Mental Health Services Administration states that about 20 percent of Americans experienced mental illness in and about 5 percent had mental illness sufficiently severe to interfere with daily life.

The American Psychiatric Association announces that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been completed and will be published in Among the changes in the new edition: In the United Kingdom, mental health patients are granted the right to choose the consultant psychiatrist who treats them, increasing parity between mental and physical illness treatments.

The change will go into effect in American psychologist Lena Brundin, from Michigan State University, and an international team of colleagues publish an article in Neuropsychopharmacology offering proof that the chemical glutamate is linked to suicidal behavior. This means that glutamate levels should be monitored in those deemed potentially suicidal and that antiglutamate drugs may help prevent suicide.

In California, the Investment in Mental Health Awareness Act of creates a grant program to help counties, public agencies, and nonprofit agencies develop mental health crisis support systems. In September, Statistics Canada releases results from a national population health survey which found that 17 percent of Canadians aged 15 or older felt they had an unmet need for mental health care in the previous 12 months. This occurs during Mental Health Awareness Week to raise awareness about mental health.

In November, Kathleen Sebelius, Secretary of Health and Human Services, announces new regulations that require health insurers to cover mental health care on the same basis that they cover physical health care. Although theoretically, mental health care parity has been required by law since , the new regulations make it more difficult for insurers to evade the law.

Centers for Disease Control and Prevention. Lansdowne, MS, Project Editor. Boyd, Lead Visual Information Specialist. Starr, Visual Information Specialists. King, Information Technology Specialists. Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors e. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs.

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This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U. CDC surveillance systems provide several types of mental health information: Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.

Mental illness refers collectively to all diagnosable mental disorders and is characterized by sustained, abnormal alterations in thinking, mood, or behavior associated with distress and impaired functioning 1. Mental illness is an important public health problem, both in its own right and because the condition is associated with other chronic diseases and their resulting morbidity and mortality. According to the World Health Organization WHO , mental illnesses account for more disability in developed countries than any other group of illnesses, including cancer and heart disease 2.

Approximately one fourth of adults in the United States have a mental illness, and nearly half will develop at least one mental illness during their lifetime 3—5.

The most common mental illnesses in adults are anxiety and mood disorders 4. The effects of mental illness range from minor disruptions in daily functioning to incapacitating personal, social, and occupational impairments and premature death 6—9. Mental illness exacerbates morbidity from the multiple chronic diseases with which it is associated, including cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer 12— This increased morbidity is a result of lower use of medical care and treatment adherence for concurrent chronic diseases and higher risk for adverse health outcomes 17— Rates for injuries, both intentional e.

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Mental illness also is associated with use of tobacco products and alcohol abuse This report summarizes data from selected CDC surveillance and information systems that measure mental illness and the associated effects in the U. The data presented include 1 the occurrence and associated effects of mental illness among adults in the United States as measured through selected CDC surveillance and information systems, 2 the CDC systems involved in the collection of mental illness data for adults and the associated public access databases, and 3 estimates from other studies and surveys, particularly those conducted by the Substance Abuse and Mental Health Services Administration SAMHSA , compared with CDC system estimates.

Public health surveillance is the ongoing and systematic collection, analysis, interpretation, and dissemination of data used to develop public health interventions that reduce morbidity and mortality and improve health Surveillance for a particular condition might depend either on collection of new data or use of data obtained from existing health information systems e.

Surveillance data have numerous uses in public health: Because a single surveillance system typically cannot accomplish all of these tasks, use of multiple surveillance systems often provides a more complete assessment of a particular disease or condition. Surveillance data are essential to the public health goals of reducing the incidence, prevalence, severity, and economic impact of mental illnesses. Public health officials, academicians, health-care providers, and advocacy groups need accurate and timely information on the prevalence and effects of mental illness to detect and characterize trends in mental illness prevalence and severity 26 ; assess associations between mental illness and other chronic medical conditions e.

For example, officials have used metal illness surveillance data to track trends in mental illness and psychological distress associated with exposure to military combat or large-scale disasters Population surveys can be used to estimate accurately the prevalence of certain mental illness symptoms across populations, and by repeating surveys over time, they can be used to detect and characterize trends.

Surveys generally cannot be used to diagnose mental disorders with the same level of specificity as an individual clinical examination conducted by an experienced psychiatrist or other mental health professional. Instead, they [Page ] collect information on a range of subjective manifestations of alterations in thinking, mood, behavior, and associated distress that correspond with clinical disorders.

Surveys collect this information using participant questionnaires that have been validated empirically to distinguish between persons with and without specific mental illnesses or general psychological distress. Estimates from these surveys vary according to the symptoms being collected and the way they correspond with various defined mental illnesses. Survey estimates usually are based on carefully defined patterns of symptoms. The most commonly used patterns correspond with diagnostic criteria agreed on by mental health professionals.

The symptom patterns used for surveys vary according to the classification of mental illness under study; changes in these classifications over time have increased the complexity of matching symptom patterns to specific illnesses. New classifications have been identified, and certain classifications have been removed. Even for relatively stable diagnostic categories e.

For example, terms used to describe depression have included major and minor depression, psychotic depression, depression not otherwise specified, bipolar disorder, dysthymia, moderate to severe depression, and mild depression. However, the relationship among the disorders described by these different terms often is unclear. CIDI also is intended for use in epidemiological, clinical, and research studies. SCID and CIDI identify overlapping but not necessarily identical populations because they are based on different classification systems. Large surveys that focus on a wide range of health topics typically can include only a limited number of mental health questions and often rely on SCID- or CIDI-validated screening instruments to provide indicators of psychiatric-related symptoms; in some cases, statistical models are used to predict the likelihood of specific mental illness in the respondent based on rating scales.

Several standardized and validated screening instruments can be used to identify persons with mental illnesses such as depression and psychological distress, with varying degrees of diagnostic sensitivity and specificity 33— CDC surveys use these screening instruments, as well as other standardized questions, to assess mental illness and other measures, such as impaired quality of life e. Depression is a major focus of population surveys of mental illness.

To meet the DSM-IV-TR definition of major depressive disorder, a person must have either a depressed mood or a loss of interest or pleasure in daily activities consistently for at least 2 weeks. This mood must represent a change from the person's normal mood; social, occupational, educational, or other important functioning also must be impaired by the change in mood. One of the most widely used and validated instruments for measuring depression in population surveys is the nine-item Patient Health Questionnaire PHQ The PHQ-9 has been used as a self-administered module in many clinical studies and telephone-administered surveys 38,40— Other telephone surveys have used a slightly shorter instrument, the eight-item Patient Health Questionnaire PHQ-8 , [Page ] which omits the PHQ-9 question concerning suicidal or self-injurious ideation because survey administrators might not be able to offer appropriate follow-up interventions.

Omitting this question in population-based surveys has only a minor effect on the usefulness of PHQ as a screen for depression PHQ-8 and PHQ-9 answers are scored using one of two algorithms, and the scores are used to assign depression categories. One algorithm is based on the DSM-IV and categorizes depressed respondents as having a major depressive disorder or other depression.

The other algorithm categorizes respondents according to the severity of depressive symptoms i. Surveys use the Kessler-6 psychological distress scale to screen for psychological distress experienced by persons with anxiety and mood disorders The Kessler-6 scale asks respondents about the frequency with which they have experienced six manifestations of psychological distress, which include feeling 1 nervous, 2 hopeless, 3 restless or fidgety, 4 so sad or depressed that nothing could cheer the respondent up, 5 that everything is an effort, and 6 worthless.

Serious psychological distress as defined by the Kessler-6 score is highly associated with anxiety disorders and depression but does not identify a specific mental illness Health-related quality of life HRQOL is a multidimensional concept that includes physical, mental, emotional, and social domains and reflects perceived physical and mental health 46, HRQOL often is used to characterize certain aspects of disease impact, disability, and injury and to identify unmet health needs and disparities among various sociodemographic populations A core set of four questions i.

HRQOL-4 asks respondents about self-rated general health, physical health, mental health, and activity limitations resulting from poor physical or mental health during the previous 30 days One indicator often used to measure HRQOL is the number of mentally unhealthy days experienced by a person. Typically, the question asks: The mentally unhealthy days question has acceptable criterion validity and test-retest reliability 48— In a large prospective study, this question predicted 1-month and month physician visits, hospitalizations, and mortality outcomes Data from health-care providers and insurers provide an additional important source of information on the prevalence of mental illness in the United States.

Coding systems used by hospitals and medical providers for billing purposes typically use the ICD-9 coding system, which, as mentioned previously, is not completely congruent with the DSM-IV-TR. In addition, mental health professionals generally use the DSM-IV-TR nomenclature, whereas primary care providers use other terminology. In practice, regardless of the diagnostic system used, diagnoses vary according to the training of the coder, local practice, availability of treatment resources, and reimbursement codes.

CDC systems for measuring the prevalence and impact of mental illness in the U. Both of these systems provide public access data sets that allow researchers to address specific queries or conduct specific analyses. In combination with information from other studies and surveys, notably surveys conducted by SAMHSA, data from these CDC systems can be used to plan, implement, and evaluate mental illness prevention strategies and to explore ways to protect and promote mental health.

Proper interpretation of mental health surveillance statistics requires an understanding of 1 the reason the data were collected e. BRFSS is a state-based telephone survey that was established in BRFSS collects standardized, state-specific data concerning preventive health practices and risk behaviors associated with infectious diseases, chronic diseases, and injuries in the adult population. Virgin Islands, and Guam. The large size of the survey permits calculation of state-specific estimates and in some cases, substate estimates and aggregated nationwide estimates.

States use BRFSS data to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. For many states, BRFSS is the only source of timely, accurate, state-based data on health-related behaviors. BRFSS interviews consist of three parts: BRFSS data are directly weighted for the probability of selection of a telephone number, the number of adults in a household, and the number of landline telephone numbers that reach a household. Data are then stratified to adjust for nonresponse, to adjust for noncoverage of households without telephones, and to force the sum of the weighted frequencies to equal the adult population in each state.

In , , and , an optional BRFSS module on anxiety and depression contained the PHQ-8, one question on lifetime diagnosis of anxiety, and one question on lifetime diagnosis of depression. In and , an optional BRFSS module on mental illness and stigma included the Kessler-6 scale past 30 days , one question on activity limitations associated with a mental health condition or emotional problem, one question on treatment, and two questions on attitudes toward mental illness that might underlie stigma.

Because certain individual states do not use these optional modules, BRFSS cannot provide national estimates of depression or psychological distress. NHIS monitors the health of the U. The basic module, which remains largely unchanged from year to year, includes three components: The family core collects information on everyone in the family and serves as the sampling frame for additional integrated surveys.

This core includes information concerning household composition and sociodemographic characteristics, tracking information, information for linkage to administrative databases, indicators of health status, activity limitations, injuries, health insurance coverage, and access to and use of health-care services.

Because certain health issues are different for adults and children, certain items on these two questionnaires differ; however, both collect basic data on health status, health-care services, and behavior. These sections of the survey yield the sample adult and the sample child data files. NHIS uses a multistage area probability design to identify representative U.

The sample is redesigned and redrawn approximately every 10 years to more accurately measure the changing population and to meet new survey objectives. The NHIS sample size approximately 10, is not sufficient to provide reliable state-level estimates for most states. NHIS sample weights, which account for the differential probabilities of selection, nonresponse, and noncoverage, must be used for all analyses.

Methods that incorporate the complex sample design and weights e. Since , NHIS has used the Kessler-6 scale past 30 days to identify serious psychological distress among adults. National rates for psychological distress by age, sex, and race are produced quarterly through the NHIS Early Release Program and are available online. In , the NHIS included three questions on lifetime diagnoses: NHANES sample weights, which account for the differential probabilities of selection, nonresponse, and noncoverage, must be used for all analyses.

Survey participants complete an interview administered in their home and then are invited to participate in an examination conducted in a mobile examination center. This includes a private interview, a standardized physical examination, and collection of biological specimens for laboratory testing. NHANES collects data on the prevalence of 1 chronic diseases and conditions including undiagnosed conditions detected through the examination or laboratory testing and risk factors e. Other topics include hearing, vision, anemia, diabetes, cardiovascular disease, osteoporosis, oral health, pharmaceuticals and dietary supplements, physical fitness, HRQOL, and health-care use.

The examination and laboratory data collected allow researchers to examine the relationships between depression and health variables not available on other national surveys. PRAMS provides population-based data that can be used to develop maternal and infant health programs and policies.

Each month, randomly selected women who have delivered a live-born infant are requested to complete a mail questionnaire; follow-up with nonresponders occurs by phone. Data are weighted to adjust for survey design, nonresponse, and noncoverage. PRAMS collects information on maternal behaviors, attitudes, and experiences before, during, and after pregnancy.

Survey responses are linked to birth certificate data. The questionnaire includes core questions asked of all participants in all states, optional standard questions pretested by CDC, and state-developed questions. Twelve control variables may be used to stratify these outcomes in an analysis. Analyses may include a single state and all available years or all available states and a single year.

CDC conducts surveys of health-care providers, and the data from these surveys complement data from the population-based surveys to provide a more complete representation of the occurrence of mental illness in the United States. For the health-care surveys, CDC collects data from a sample of organizations that provide health care e. The data can be used to examine factors that influence use of health-care resources, quality of health care, and disparities in health-care services in population subgroups.

In addition, because the surveys collect core information from a sample of providers that remains relatively stable over time, trends in the types of care delivered in each setting can be monitored and examined in relation to the characteristics of providers, patients, and clinical management of patient care.

NAMCS uses a multistage probability sample of visits to office-based physicians and health-care providers in community health centers and collects data on provider characteristics. Sample data are weighted to produce national estimates that describe the provision and use of ambulatory medical care services in the United States. Public use data files are released annually and include a visit statistical weight and since a physician statistical weight.

Information on mental health and mental illness available from NAMCS includes reasons for visit, physician diagnosis, medications, treatment, referrals, and one item on comorbid depression.

Physician diagnoses are recorded as written by the physician text or ICD-9 codes. Nosologists convert text to ICD-9 codes for the data files.

NHAMCS involves a multistage probability sample of visits to the emergency and outpatient departments of noninstitutional, general, and short-stay hospitals in the United States. Federal, military, and U. Department of Veterans Affairs hospitals are not included. Data from emergency department visits are slightly different from the outpatient department data and include whether the patient was admitted to a mental health unit or transferred to a psychiatric hospital.

Sample data are weighted to produce national estimates. Public-use data files are released annually. NHDS does not include federal, military, U. Department of Veterans Affairs hospitals, prison hospitals, or hospitals with fewer than six beds. Hospitals are selected by using a three-stage stratified design. Patient information collected includes demographics, length of stay, diagnoses, and procedures. Hospital characteristics collected include region, ownership, and number of beds. NHDS sample statistical weights account for nonresponse and must be used for all analyses. Methods that incorporate the complex sample design and weights, such as Taylor series linearization, must be used to calculate appropriate standard errors.

NNHS provides information on nursing homes from the perspectives of the provider and recipient of services. Data on facilities include characteristics such as number of beds, ownership, affiliation, Medicare and Medicaid certification, specialty units, services offered, number and characteristics of staff, expenses, and charges. Data on current residents include demographic characteristics, health status, up to 16 current diagnoses, level of assistance needed with activities of daily living, vision and hearing impairment, continence, services received, and sources of payment.

The survey uses a stratified two-stage probability design. The first stage is the selection of facilities, and the second stage is selection of residents. Through the surveys and surveillance systems described in this report, CDC provides prevalence estimates on current depression, postpartum depression, psychological distress, number of mentally unhealthy days, and lifetime diagnosis of depression, anxiety, bipolar disorder, and schizophrenia in the U.

CDC health-care surveys provide health services information about physician, hospital outpatient, and emergency department visits related to mental illness. All of these CDC systems can provide data for national-level or nationwide estimates by sex, age, race, and ethnicity. Two CDC surveillance systems provide estimates for current depression: For example, using continuously collected data from — the most recent data available , results from NHANES indicate that 6.

Results from BRFSS for current depression measured by the PHQ-8 vary according to the year conducted because in different years, a varying number of states might have administered the optional modules containing the mental illness—related questions. Virgin Islands using the PHQ-8 indicate that approximately 8. Results from in 16 states using the optional BRFSS anxiety and depression module indicate that 8.

Prevalence estimates were higher among women and non-Hispanic blacks compared with other groups Table 3. BRFSS state-specific prevalence estimates for depression in and show marked variations from state to state, with prevalences ranging from 4. The prevalence of depression was generally highest in the southeastern states Figure 1. During —, a total of The prevalence of postpartum depression varied by age, ranging from Among 22 states, the prevalence of postpartum depression ranged from 9.

NHIS data indicate that in , 3. BRFSS included the Kessler-6 in the optional mental illness and stigma module during administered in 35 states, the District of Columbia, and Puerto Rico and 16 states. Among participating states, prevalence estimates were similar in 4. As in NHIS, women were more likely to have serious psychological distress than men, and rates were highest among adults aged 45—54 years and non-Hispanic blacks. BRFSS data for state-specific prevalences of serious psychological distress during and indicate that, like depression, prevalence varied among states, ranging from 1.

The prevalence of serious psychological distress was generally highest in the southeastern states Figure 2. The question on number of mentally unhealthy days is included in the BRFSS core questionnaire; therefore, data are available for every year for all states and territories.

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