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Hello TCV readers, welcome to this new subsection of News. This year, News Editors will be producing a “Question the Numbers: The Backstory of Statistics” series in which we examine commonly circulated statistics and work to make sense of what they mean, and how they might be limited in representing a given situation. Since numbers are often treated as neutral or objective we hope to use this section to explore this assumption and better understand what purpose it serves. Have any thoughts, questions, or suggestions for what numbers to feature? Reach out to the News Editors at aacheson@conncoll.edu and eroy1@conncoll.edu.
In 2019, the National Alliance on Mental Illness (NAMI) reported that nearly 20 percent—or 1 in 5—adults in the United States experience a diagnosable mental health condition each year. These numbers are based on results from the National Survey on Drug Use and Health (NSDUH), which selects a sample group of the population to participate in the study, and then adjusts the data to the general population. This year, for example, approximately 70,000 participants have been selected. The National Survey on Drug Use and Health states that “households are randomly selected through scientific methods” but does not specify exactly how their selection methods can be both “random” and “scientific.” Additionally, the survey emphasizes that participation is very important because “no household can take your place,” but again it does not adequately explain why. We also have very little available data as to how representative these randomized samples are of the general population. While a well-written survey distributed to a large, randomized sample, like the one used in this study, is one of the most accurate means to understand overall trends in a given population, it does not portray a perfect representation. It is important to remember that the 1 in 5 estimate is just that—an estimate—and should not be treated like concrete data.
The survey itself is conducted by a representative from RTI international, a group that defines themselves as “an independent nonprofit research institute dedicated to improving the human condition.” Based on guidelines listed on the NSDUH’s website, the survey consists of an online questionnaire that the participants fill out directly into a computer provided by an RTI representative. While this method of data collection might be very convenient and incredibly popular, it has its limitations. Surveys are typically reliable in that all the questions are standardized, and their low cost makes it easy to retrieve data from a large number of people and generalize findings more accurately. However, they are also inflexible and lack depth. In the case of mental health, these limitations can be particularly problematic when trying to assess a topic as variable as the number of adults suffering from mental illness. Each individual’s circumstances can differ quite significantly, and certain objective questions may not fully capture a respondent’s likelihood for having a diagnosable mental health condition.
Furthermore, it is important to note that the 1 in 5 figure is based on the assumption that all adults with a mental illness could be diagnosed as such based on criteria outlined in the Diagnostic and Statistical Manual (DSM), which is the book most widely used by mental health professionals to assist in diagnosing mental health conditions. However, a person’s mental health cannot be categorized into checklists. The DSM inherently has strict limitations and has recently faced stark criticism; even the NIH states that it “[does] not reflect much of what we now understand about the processes related to mental disorders.” Many psychiatrists and other mental health providers now understand that these illnesses exist on a spectrum, and are adjusting their diagnostic methods to reflect the newest research.
Given all of the above limitations, claiming that 1 in 5 adults in America suffer from a mental illness is very likely an understatement, even before the devastating impacts of COVID-19 — and we currently have no better means to assess what the real number might be. These statistics presented by NAMI may help initiate conversations related to mental illness, however, regarding them as absolute only marginalizes those suffering with their mental health who do not have a diagnosable illness in our current classification system.
Though it is difficult to give precise estimates at this time, the above numbers are expected to worsen after the pandemic. Those with pre-existing mental health conditions have found their conditions worsening due to quarantine and disruptions in daily life, while rates of anxiety or depression related symptoms have significantly increased among the general public. Based on a survey conducted by KFF, 36.5 percent of respondents reported symptoms of an anxiety or depressive disorder per week during June, compared with only 11 percent in the same survey conducted during January. While no statistics were provided, one NIH study predicts that rates of psychosis will increase in relation to the pandemic. Among those with pre-existing mental health conditions that were previously in remission, disruptions due to the pandemic have caused high rates of recurring symptoms. Based on one study published in the International Journal of Eating Disorders, nearly two-thirds of survey respondents from the U.S. in recovery from anorexia nervosa reported increased rates of restriction and fears about being able to remain consistent with their meal plans, while one-third of those recovering from bulimia nervosa or binge-eating disorder reported increased incidents of binge eating. For patients with OCD, a global health crisis presents unparalleled challenges. Roughly 30 percent of those with OCD experience fear of contamination, and observing this widespread emphasis on hand-washing, cleanliness, and hyper-vigilence can be extremely anxiety inducing and even debilitating.
For all Americans, access to care has become extremely limited. While telemedicine is a well supported method of providing psychiatric care, in-person social interactions and a solid support network are often a key component of treatment that is being severely compromised in a time of social-distancing. Based on the same NSDUH survey mentioned above, only 43.3 percent of Americans received treatment for a diagnosable mental illness in 2018, and many of those with severe illnesses may not have reliable access to health insurance or an internet connection sufficient to support video-conferencing.
In the current state of the world, it is more important than ever to stay as connected as we can. Remember that mental illness can’t always be seen from outside, and a person may be suffering deeply without ever displaying any overt symptoms. During times like these, it is of utmost importance to reach out and offer kindness, while also taking enough time for ourselves. Together, we can foster a supportive community who equally prioritizes overcoming a physical illness and our mental well-being.•
