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Depressed? Anxious? Aren’t we all?

DUKE (US)—A long-term tracking study of more than 1,000 New Zealanders from birth to age 32 suggests that people vastly underreport the amount of mental illness they’ve suffered when asked to recall their history years after the fact.

“If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders,” says Terrie Moffitt, the Knut Schmitt-Nielsen professor of psychology and neuroscience at Duke University.

Because self-reporting from memory is the basis for much that is known about the prevalence of mental disorders, anxiety, depression, and substance dependency may actually be twice as high as previously believed, according to new research.

Moffitt says longitudinal studies like this one—the Dunedin Study—that track people over time are rare and expensive.

Jane Costello, professor of medical psychology at Duke, runs a similar project, the Great Smoky Mountains Study, which tracked 1,400 American children from age 9-13 into their late 20s and found similar patterns.

“I think we’ve got to get used to the idea that mental illness is actually very common,” Costello says. “People are growing up impaired, untreated, and not functioning to their full capacity because we’ve ignored it.”

The latest analysis from the Dunedin Study found 41 percent of the age range had experienced clinically significant depression. The study also reported a lifetime rate of alcohol dependence between ages 18 and 32 at nearly 32 percent.

Guidelines published by the American Psychiatric Association that set the bar for defining what is and isn’t a treatable illness are currently being revised by a rewriting of the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM).

Given the findings of recent longitudinal studies, the stringency of the diagnostic criteria may need to be reconsidered, says Moffitt, who is on the committee writing the new DSM-V standards.

“Researchers might begin to ask why so many people experience a disorder at least once during their lifetimes and what this means for the way we define mental health, deliver services, and count the economic burdens of mental illness,” Moffitt argues.

At the very least, maybe these findings can help reduce the stigma against mental illness and mental health care, Moffitt adds. New Zealand, for example, has begun a new campaign of public service announcements featuring sports heroes saying they’ve experienced mental health issues.

“If we’re serious about this problem, we need to get serious about preventing it,” Costello says. “We do know a lot more about prevention now.”

The Dunedin Study findings appear online in the journal Psychological Medicine. The work was supported by the New Zealand Health Research Council, the US National Institutes of Health, and the UK Medical Research Council. Psychologists at Duke University and their colleagues from the United Kingdom and New Zealand participated in the research.

Duke University news: www.dukenews.duke.edu

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13 Comments

  1. Thomas Raymond

    In America the Pharmicutical Companies and the Insurance Companies, Through their Lobbyist have turned the Helath Care System in the U.S.A. into a shame, not to mention Banckrupcy. Alternative medicines are good, but not covered. I’ve dealt with Mental Illness from Drug Abuse and its all about the $ dollar. Plain and simple

  2. Rachel Steele

    There is a big, big difference between the short term, mild depression the author is talking about that everyone allegedly experiences, and the disease of major depression. There is also a big disconnect between the understanding of people who have only experienced the one, but think that makes them experts, and those who suffer from the serious disease and know “they just don’t get it.” Asserting that we have all been depressed at some time, and should act on the little understanding we come away from that experience with, may not be helpful to people experiencing chronic major depression. Indeed it may hurt them. A little knowledge can be a dangerous thing.

    One example of this took place in a legal setting, as reported in Nashville’s “Tennessean” newspaper on November 28, 2008. At a contempt hearing for a party who had not been able to retrieve money from a Swiss bank as ordered by the judge, Chancellor Carol McCoy, the party’s attorney presented as explanation for his client’s inaction the sworn affidavit of a Nashville psychiatrist . The psychiatrist testified that the defendant was not competent to perform the task as ordered because he was suffering from acute depression and he was not yet successfully medicated to relieve this state of acute major depression. Those of us who have suffered from acute major depression can appreciate how it can freeze one’s ability to perform even the simplest tasks in the absence of successful treatment, by medication or otherwise. But Chancellor McCoy tossed off the psychiatrist’s testimony and instead relied on her own experience dealing with “problems.” According to the “Tennessean’s” story, the judge belittled the party’s acute depression and paralysis, confirmed by the doctor, saying “We’ve all got problems and I’m not going to tell you mine…but I’m sitting here doing my work.” No judge would cavalierly substitute her judgment for that of a physician testifying about the competence of a patient in the acute stages of cancer. But I have suffered from recurrent major depression off and on for 25 years, and my experience has been that people will consider themselves experts on the capabilities of people suffering from prolonged major depression. They feel free to do this just because they themselves have experienced grief, the “blues,” an isolated incident of short term minor depression, or just had “problems” like this judge. They will substitute their ill informed perceptions for my judgment or my doctor’s, and if they are in a position of power and are making a decision, someone like me or the litigant in front of Chancellor McCoy can lose and lose alot.

  3. Greg

    Rachel is right. If you haven’t had weeks on end of days in which simply getting the vacuum cleaner out of the cupboarrd was more than a day’s work — let alone plugging it in — then you have not experienced depression. You’ve just been a bit down.

    So the answer to the headline question is no. Few people get depressed.

    It’s time for the medical profession to stop this irresponsible nominal inflation. It is probably killing people.

  4. Barbara Axt

    Well, if so many people have some episode of mental illness in their lives, maybe we could conclude it’s NORMAL? That maybe it is part of life and we have to DEAL with it, not rush to TREAT every thing?

  5. Adair

    @Greg, that standard’s ridiculous. If I can, say, make it to class and get some food at least once most days but spend most of the day catatonic, or can’t focus in class because I have nightmare images of my professor and myself being corpses and so on superimposed over the reality, which I keep struggling to bring back into view, and I believe that I’m failing out of school every semester when I’m not (although getting ever-closer as a self-fulfilling prophecy) and that everyone hates me and I can have no friends, and curling up and crying in existential crisis for hours a week, then I’m sick. You can have varying degrees of a disease.

    Additionally, plenty of people commit suicide without ever having appeared as debilitatingly depressed as you set as the standard. Should people try to intervene on the part of someone who’s going through the motions of life while miserable and hopeless?

    Being bedridden from depression sucks. It sucks quite a lot more than mere emotional agony and one’s own unpredictable behavior and mood swings, I’ll agree with that. I’d take a screaming suicidal fit over being bedridden any day. But someone who can be a productive worker yet derive no pleasure from life, rely on alcohol, and just be a general dark, stormy presence, get involved in abusive relationships, blablabla–if they can benefit from treatment, we all benefit if they get it.

    @Barbara Axt

    You sound ignorant. Treatment is dealing with the disorder. Treatment for me right now involves valerian root, self-care, social networking, and developing life skills after growing up with severe, untreated mental illness. So much of what I believed and obsessed about before simply isn’t relevant or accurate to the “real world”, where I’m gonna have to provide myself with food and shelter and try to be a decent friend to the other people in my life. If I hadn’t treated my mental illness as an illness and sought help from others who’d experienced it and from services directed toward it, I’d still be caught in the mess of self-blame and criticism based on values I don’t even hold anymore.

    There is a degree of fear that you can’t simply deal with. You have to buckle down and just wait it out, when you’re seeing demons or seeing spiders everywhere when they’re not really there. You spend weeks unable to touch anything on your floor because you think it might be contaminated. You go mute whenever you’re around people other than your family, who you can speak to in monosyllables, or the couple trusted friends you might see once every few weeks. Turning a corner evokes the same emotional response as stepping off a platform high up in a tree.

    Anxiety does other things, too–you starve yourself to 60% of your recommended body weight. You start picking out your body hairs with tweezers and end up picking at your skin and go all the way to the muscle. You spend hours in a trancelike state in front of a mirror, miming holding a gun to your head, every day. You wake up hours before you have to get up and spend hours trapping in agonizing loops of thought, and can’t break out on time to get to school or work. You procrastinate on homework so much you’re failing classes where you’re making 98/100 on the exams. You’re constantly nauseous because you compulsively eat every time you think about doing homework. You don’t have any concept of doing anything for pleasure–everything you do is a compulsive reaction to your own fears.

    A lot of people might have some of these symptoms, and you could deal with them fine. I’ve been doing it for years, and it isn’t really that bad. But when they dominate your life to the extent that you decide it’s worthwhile to try treatment–well, then that’s when you should try treatment. Which isn’t without its risks and costs, so you can also later decide to discontinue if it doesn’t seem like the benefits outweigh the costs.

    The entire idea of studying mental illness and developing resources for those with psychological problems is to find out and facilitate the best way of dealing with them. Does it matter whether those problems are considered debilitating by our work-obsessed culture? “Lesser” problems cause aggression and miscommunication. They contribute to alcohol, abuse, codependence, and poverty. They worsen physical health. They create environments where children can grow up hopeless. They restrain creativity and self-fulfillment. I agree that there’s serious problems when it comes to how professionals, researchers, and the public describe these issues, and that ambiguity’s not going away any time soon. But I highly doubt people realizing, “Hey, I shouldn’t be miserable all the time!” and “I can talk to someone about the emotional reasons for why I’m failing socially, academically, in work, or at home,” is invalidating. Someone with an experience of mild depression and who uses the word depression to describe such chronic mood states may not know about serious cases of depression or what that means for the sufferers, but who seriously thinks that their experiences will make them *less* likely to listen to the needs of someone with major depression? They’re consciously and unconsciously striving to live up to the role they’ve put themselves in–someone who accepts mental illness as valid and wants to spread its message.

    And someone with mild depression who doesn’t understand why, for instance, it took me seven months to change a lightbulb and who wants me to “just do” something isn’t any worse than they would’ve been before they adopted the word and a faux-understanding of depression–back then they would’ve told me the exact same thing.

  6. MichW

    I agree with Barbara Axt; maybe it’s just part of life to occasionally feel really down. Maybe it’s part of being human to not always function at “full capacity”. Maybe we’re supposed to experience a full range of emotion and behaviour and to learn from it, to learn to empathise from it and to learn how to deal with the entire gamut that life throws at us.

  7. Barbara Axt

    Adair, I may have sounded ignorant, but I’m not. What I mean is that real persistent mental illness has to be treated (severe anxiety, depression, etc etc), of course. But feeling very, very bad after the death of a relative, a divorce, etc (even if it prevents you from functioning) is absolutely normal and should be respected, not always treated. All of us are going to have episodes of deep sadness in our lives, and it’s important to accept that.

    Being expected to function at 100% of our capacity 100% of the time throughout our lives – that’s cruel. And that’s what I meant.

    I believe MichW understood what I meant.

  8. kim

    Barabra and MichW,
    I am sorry, but you just don’t get it. We would not expect someone with a heart that is not working in the “normal” way to accept it. No, we send them to a cardiologist. We give them medicine to change the chemistry in their body to regain normal activity of the heart. We ask them to change their lifestyle to help their heart heal and not become sick again. If they have another heart problem, we don’t blame them for it. We treat the new problem.

    When someone is depressed their brain is actually not workiing in the “normal” way. It does not matter whether it is from a significant loss or a genetic predisposition, their brain is producing reactions to life differently than when they were not depressed. The neurotransmitters and electrical signals in the brain are stimulating, over stimulating or not stimulating different parts of the brain. (Depends on the type of depression) When someone is grieving a loved one, a lost job, bankruptcy, loss of face, or the end of a marriage, their brain is not working the same way it did before the loss. The degrees of depression vary, but its effects on the brain our measurable.

    Luckily, we know more about depression than we did ten years ago. We have numerous effective treatments. Unfortunately, in our country treating a brain with an illness has a stigma. While treating a heart with an illness deserves everyones support, attention and resources.

    Our refusal to adequately treat brain illness, leads to suicides, self-medication (sometimes drug addiction), failures in personal and professional lives, homelessness and sometimes incareration.
    In the mental health community the standard joke is the largest population of institutionalized mental patients in the LA County Jail.

    I ask you to rethink the acceptance model. Better yet, next time you think your having a heart attack – just accept it. Tell your family, yes the tingling in my arm will go away with time if we all just accept it as normal. If you have a child born with a hole in their heart, don’t seek treatment. That’s embarassing, accept it. Maybe a few leaches will work.

    We only know a small amount about the brain, but within the next 10 years even you will see a sick brain deserves treatment just like any other organ in our body.

  9. Evelyn

    I don’t think Barbara is arguing that depression itself shouldn’t be treated. From what I’m reading, it seems more that she’s arguing that not all sadness is depression, and treating all sadness as a mental disorder is inherently unhealthy. In many ways, it’d be like taking vicodin for every bruise and stubbed toe, when it’s better to match such things with more severe problems. No one’s arguing that depression shouldn’t be treated, only that not every person feeling “down” should be assumed to be depressed.

  10. Phil

    Evelyn, You are living proof of a point that has been made several times in this discussion – i.e. that someone who has not experienced a clinical depression has no idea about…

    1) the absolute incapacity that a clinical depression can cause; it’s a *brain disease*, and it can be *seen* in MRI scanning. Try to read up a little, or go visit a psychiatrist and ask about this. Again, clinical depression is a *disease*. Try getting used to thinking about it that way. It’s not “being in a funk”, or being in a bad mood”, or “not feeling like doing anything”; it’s a *whole body disease that often leads people to *suicide* if not treated. Would you like to see a loved one go through this and take a chance that they’ll survive it? I wouldn’t, because I have seen what this disease can do, up close and personal, twice.

    2) How *minor* depression that goes on for years, untreated, never reaching clinical proportions, can so thwart a person’s ability to function that an entire life can be 90% wasted for lack of access to simple therapies that are as effective or almost as effective as drugs? Have you any idea that many people who smoke, or drink, or use recreational drugs, or eat too much are actually treating themselves with substances that will cause them physical harm in the long run – and more expensive medical care in the long run.

    Sure, there are ups and downs in life, and not every sad or bad or angry mood shuold be subjected to ‘formal” treatment, but there are *10′s-of-millions* of people, and I would venture to say probably in the low *billions* worldwide, who at one time or another suffer from real psychological and depressive malaise to a degree that ranges from life-altering, to life-ending. Why not treat that? Why not let people know there is a pathway to help them feel better? Is that being weak? On the contrary; that’s being *smart*.

    Treating even minor mental illness is *the right thing to do*. It will help sufferers be better parents, better workers, better members of society – and they won’t lose the ability to “handle the hard times”. On the contrary, they will *gain* the ability to handle the normal ups and downs of daily life in a way that doesn’t lead them to addictive dependencies, obsessive self- absorption ,or outright self-destruction (while taking others along with them).

    In a word, have *empathy* for those who suffer, including one’s self. Being “tough” won’t cure a cancer, nor will it cure a clinical or lifelong dysthymia (low level depression). Why? Because both cancer and depression are *diseases* that can now be seen and measured with medical instruments. It’s about time the ignorance about mental illness stopped, because that ignorance leads to ineffective self-treattments, as well as social perceptions about those who have mental illness that cause those with mental illness to be victimized twice – once by their illness, and again by those who should help them, and empathize with them.

  11. Barbara Axt

    I would need to write a whole book here, about myself and about some very close friends, to explain my point, but I don’t have the time and I believe you wouldn’t like to read it all anyway.

    So, I’ll just say that I’m very happy a few people understood my point. I sincerely believe that establishing a standard of how people “should” feel and how “happy they should be” – and treating every minor deviation of the norm – causes a huge lot of suffering and anxiety, not to mention that it completely disrespects individual differences.

    Treating every minor (attention to the word “minor”, for christ sake!) bruise (in the mind or in the body) may not always be the way to go. (unless by “treating” you mean, in some cases, “learn to live with a few things you can’t change,” in which case I completely agree)

    Anyway, it took me a long time to figure this out. If you don’t agree, that’s fine.

  12. Terrie Moffitt

    Responding to Rachel Steel’s comment of 17 September, which assumed that our research was about mild depression and not the disease of depression. We reported that depression, anxiety disorders, alcohol dependence and drug dependence (diagnosed by the standards of the American Psychiatric Assn) were very common when the diagnoses were made by assessing people repeatedly for many years. Prior estimates of low rates of these illnesses came from studies that assessed people only once, and asked them to remember back for many, many years. Our research team considered whether the high rates we got represented only mild cases, but they did not. In fact, we included other studies of people whose depression was so severe that they were hospitalized for it. When these patients were followed up years later, half of them reported to researchers that they had never been depressed. Our point was that most of us have the idea that disabling mental disorders are rare, but we got this idea from research that relied on faulty retrospective memory.

  13. Linda Vensel

    I would just like to say that living with a mental illness is living in another world, I have Severe Anxiety Disorder, Seasonal Depression, Depression, along with Post Traumatic Stress Syndrome. Pointing out what one of the comments that says about how someone in your family is having numbness in their arm and tingling in the heart, is a perfect example of what could be a panic attack, that is what having a panic attack is sometimes on a daily basis or 1 or more times a day, imagine that and you will know what many are going through, Learning how to control and convince yourself you will be okay when you feel like your going to die , does that not need attention, yes it does, by your own mind, not a doctor, you have to retrain your whole way of thinking so you can control your panic attack to come on 20 minutes maybe before it even happens, rapid heart beat, sweats, nausea, can’t stand anyone around you, to the point you just need to lay down, Me, some may just pop a pill, others may deal in different ways and can do that, just like a heart patient recovers quicker than others or never recovers and has lost oxygen to the brain to lead onto another diagnoses. comes on. My point is, People wake up and let Mental Illness take it;s course so we as humans can take ours without stigmata in our way, Thank you.. LInda

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