Adults Often Under-Report Mental Health Issues

By Jane Farrell

Mental disorders among adults may be substantially underestimated over the course of their lifetime.

Researchers from the Johns Hopkins Bloomberg School of Public Health found that there were serious discrepancies among mid- and late-life adults in reporting past and present mental disorders, including depression, compared with the reporting of physical disorders such as hypertension.

The study, led by postdoctoral fellow Dr. Yoichiro Takayanagi, was published in the journal JAMA Psychiatry.

“The takeaway is that lifetime estimates based on [participant] recall…underestimate the occurrences of mental disorders over the lifetime,” said Ramin Mojtabai, MD, PhD, MPH, MA, associate professor in the Bloomberg School’s Department of Mental Health and senior author of the study.

Researchers based their findings on interviews in 2004 and 2005 with 1,071 adults who had participated in a study that lasted 24 years.

When asked to give “retrospective evaluations” in six categories – major depressive disorder; obsessive-compulsive disorder; panic disorder; social phobia; alcohol abuse or dependence and drug abuse or dependence – participants underreported their disorders even though they had reported them at least once in previous assessments.

On the other hand, they were likelier to report incidence of physical disorders — diabetes, hypertension, arthritis, stroke, cancer – that were very similar to previous assessments in the study.

Over the length of the study. the participants were also interviewed using a technique devised to determine whether a psychiatric condition exists.

The study found that the participants’ lifetime estimates of mental disorders ascertained by retrospective recall versus cumulative evaluations were 4.5% versus 13.1% for major depressive disorder; 0.6% versus 7.1% for obsessive-compulsive disorder, 2.5% versus 6.7% for panic disorder, 12.6% versus 25.3% for social phobia, 9.1% versus 25.9% for alcohol abuse or dependence, and 6.7% versus 17.6% for drug abuse or dependence.

But participants showed better past and present understanding of physical disorders:18.2% versus 20.2% for diabetes, 48.4% versus 55.4% for hypertension, 45.8% versus 54.0% for arthritis, 5.5% versus 7.2% for stroke, and 8.4% versus 10.5% for cancer.

The authors said that the difference might be due to varying ages of onset of the disorders and to the fluctuating nature of mental illness. The stigma associated with mental illness might also be a factor in reporting, as well as the relatively inexact nature of diagnosing a mental health issue.