The Culture of Distress

There's more mental illness in America than anyone previous or suspected. The first nationally representative survey reveals that nearly one-half of all Americans between the ages of iS and 54 have experienced an episode of psychiatric disorder some time in their lives, 30 percent of them within the past year.

What's more, most mental illness tends to cluster in a small number of individuals, according to the results of the National Comorbidity Survey. Fifty-six percent of people with a history of one psychiatric disorder also suffer from a multiplicity of others. Roughly 5.2 million Americans account for 90 percent of all episodes of severe mental illness each year.

The clustering of psychiatric illness in one patient, or comorbidity, makes psychiatric disorders harder to diagnose and more difficult to treat.

Spearheaded by Ronald C. Kessler, Ph.D., of the University of Michigan, the survey is the first to administer a structured psychiatric interview on a national scale. It provides a comprehensive picture of how and where mental illness strikes Americans, as well as risk factors.

The findings included a couple of surprises: Although they face generally inferior financial and economic conditions than whites, blacks have a lower incidence of anxiety disorders and substance abuse. And contrary to the findings of other studies, Americans living in rural areas were no less likely than their urban counterparts to suffer from a lifetime of or one-year psychiatric disorders.

Among the findings:

• One sixth of the population suffers from one or more lifetime psychiatric disorders. Only 40 percent of them ever receive psychiatric care.
• Men exhibit higher rates of substance abuse and antisocial disorders than do women, who seem to suffer more commonly from affective and anxiety disorders.o Seventeen percent of the population have suffered one or more episode of major depression at some time in their lives.
• The highest overall rates of mental illness occur between the ages of 25 and 34, then decline with age.
• The rates of almost all disorders decline with income and education, with the exception of lifetime substance use, which is significantly higher among the middle-education group.
• Lifetime substance use disorders and lifetime antisocial personality disorders are highest in the West, while lifetime anxiety disorders are highest in the Northeast.

It's official! New York City is indeed the Big A for anxiety.

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