One much-publicised finding of the National Health Survey carried out by the ABS is that the self-reported mental health of Australians is declining. In the 1995 survey, 5.9% of the sample reported ‘mental and behavioural problems’, which increased to 9.6% in 2001 and 10.7% in 2004-05. An earlier ABS survey, carried out in 1989-90, came up with lower figures than 1995 – 3.8% reporting ‘nerves, tension, nervousness, emotional problems’ and 0.9% reporting depression. However, its question was different so comparisons should be made with caution.
The rapid increase has led to widespread concern, but also suspicion that there is something wrong with the numbers. Will Wilkinson has long argued that the depression trends (which are similar in the US) are fishy because they don’t match the happiness data. If there was a big increase in depression there should be a substantial increase in those with lower happiness ratings in subjective well-being surveys, but there is not in the US or UK.
In Australia, it’s harder to test this hypothesis because of inconsistent survey formats. In 1983 and 1984, two surveys giving very/fairly/not too happy options found 6% giving the ‘not too happy’ response. The two most recent surveys, the 2003 and 2005 Australian Survey of Social Attitudes, used 0-10 scales. If we count 0 to 4 as ‘unhappy’ we get 6.5% and 8.2% of respondents respectively as ‘unhappy’. The 2003 survey would seem to show little change in 20 years, consistent with what Will finds. The 2005 survey shows a more significant change. But both are below the mental problems reported in the National Health Survey.
I’m less convinced than Will in his original post on unhappiness and depression that this shows that the mental health figures are wrong. As I argued last month it’s possible to combine some mental health issues with an overall report of happiness. And when people say they have depression, they could mean that they have it as an underlying condition, but that their medication means that their current feelings are ok. With about 5% of the adult population on anti-depressants according to the National Health Survey this is at least a possible interpretation (Will makes a similar point in the post linked to below).
In another post late last week, Will offered an argument I find more convincing, which is that we are witnessing diagnostic inflation. He was using a New York Times report of an article in the Archives of General Psychiatry which argued that ordinary sadness at a loss was being misclassified as ‘depression’. Sadness can lead to depression, but it is not depression in itself, and would not have been classified that way by most people in the past. Perhaps consistent with this, in the mid-1980s reported unhappiness was above the rates of anxiety and depression reported in the ABS survey at the decade’s end.
Because anti-depressants often do bring relief, there is an incentive to classify one’s feelings as ‘depression’ to persuade a doctor to write a prescription, even if what people are actually feeling is no worse than what people in the past felt when they described themselves as ‘sad’ or ‘down’. In my one experience of feeling down for a sustained period of time, when my PhD was going badly in 1992, I don’t think it ever occurred to me that I had a medical problem. I had an academic problem, which was flowing through into a career problem, as at that time I (foolishly) wanted to be an academic. I went looking for a different job, not a doctor. Though the whole experience was mild compared to what I have seen in others, if it happened again I probably would at least consider (temporary) medical help in a way that I did not back then. I suspect this changed way of looking at things is widespread and at least partly explains the apparent rise of mental ill-being.