Is mental ill-being increasing?

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.

18 Responses to “Is mental ill-being increasing?

  • 1
    conrad
    April 11th, 2007 07:12

    The alternative to Wilks’ argument is that it is not being overdiagnosed now at a greater level, it was being underdiagnosed in the past. There are certainly obvious groups out there where this would have occured due to social constraints being relaxed (Males, for instance). There have also been general trends that would lead to greater levels of depression (like aging) and I’ll just guess becoming fatter.

  • 2
    Andrew Norton
    April 11th, 2007 08:47

    Conrad – Women are still much more likely to report anxiety or depression than men, but past under-diagnosis could be part of it. And you are right that there are medium-term trends that could help explain a real increase in depression, but also some that would reduce it, such as lower unemployment.

    I’m not sure about obesity; the National Health Survey reports that about half those reporting a mental problem are overweight or obese, but that’s very similar to the general population.

  • 3
    Russell
    April 11th, 2007 14:57

    The ‘self-reported’ data is dubious – a copy of that Seligman book on Authentic Happiness has just reached me via the local library, and has a happiness quiz in it which I skipped over as it was impossible to give meaningful answers.

    I’m not sure if you’re talking about mental illness or just unhappiness. You’re “feeling down” episode is just normal life – depression has no feeling, no meaning, no reason to get out of bed, no nothing.

    I was trying to think of other indicators – calls to telephone ‘helplines’, suicides, use of drugs, road-rage, body-piercing surely … but as you say these could be not an increased incidence of mental troubles, just an increasing amount of talk about them. Kennet with Beyond Blue, Gallop with his episode, the internet (what a boon for hypochondriacs) .. there’s a whole popular discourse which says that it’s perfectly normal and OK to have the odd patch of real mental distress.

    I have a suggestion worth trying: more arts funding! Given the decline of religion as a source of meaning for many people. I think the the arts can to some extent substitute as a carrier of deep meaning. In the previous thread someone said I was just trying to impose my preferences on others – not true – these aren’t my purely personal preferences. I’m talking about ‘the canon’ – a long tradition. To say it’s a personal preference would be like saying to an Aboriginal elder “just because you like those old stories doesn’t mean the young kids wnat to hear them – they’ve got DVDs and cable”

  • 4
    Francis Xavier Holden
    April 11th, 2007 15:35

    I’m sure there has been an underdiagnosis of clinical depression in Australia in the past and even now. Which leads me to I think the big issue. It seems to me that this modern society (pan-usa in inclination) does not value what we might have called stoicism. In fact we elevate the opposite of stoicism in such things as a “passion for selling mobile phone plans” and valuing self indulgent emoting instead of reason and coping.

    In this context I’m assuming it’s more conforming to answer questions about “mental health” with more sadness and down answers. Partly diagnostic inflation.

    Incidently if a person is prescribed anti depressants and isn’t clinically depressed then the drug won’t “make them happy”. The placebo effect may lift their mood but anti-depressants don’t have a record of creating happiness.

  • 5
    Russell
    April 11th, 2007 23:28

    Only tangentially related but if anyone has time for a longish article this is nice:

    http://www.washingtonpost.com/wp-dyn/content/article/2007/04/04/AR2007040401721.html

    One of the comments on the article has “Music education in this country has been on the decline for the past 20 years. Without education, all the average citizen can hope to appreciate is the popular music that crowds out sanity on the popular radio stations. It is the musical equivalent of the survivor television shows. If we dont educate our people we will continue to be a culture that is circling the drain”

  • 6
    Sacha Blumen
    April 11th, 2007 23:39

    That’s a silly and snobbish quote. I did a lot of “classical” (or art) music when I was young (I got an AMusA in piano at 17) and I’m familiar with some art music lovers’ snobbish attitude to non-art music – I used to listen to classic FM and you hear that snobbishness from some of its presenters. What’s wrong with popular music? Why does “popular music crowd out sanity?” If you don’t like it, don’t listen to it!

    I do think that, at the least, art music of today and of previous centuries has a place in education, even if only in looking at what was influential or popular in the past or looking at what has led to the existing music.

  • 7
    conrad
    April 12th, 2007 07:26

    I agree with Sacha — I generally don’t like commercial music but the idea that it isn’t somehow real is just snobbishness. I think the deeper issue is snobbishness over what “real” values are and somehow if you don’t have these values it leads to mental ill-health. I think its just a weird conservative delusion that somehow some form of old stereotyped values are better than somehow new values and that the former of these protect you from mental disease and the latter don’t.

  • 8
    Russell
    April 12th, 2007 10:03

    Sacha – nobody has said there’s anything wrong with popular music (my piano teacher was the strictist of the serious old-type teachers but she loved Sammy Davis Jnr). But I think the commenter is right – “Without education, all the average citizen can hope to appreciate is the popular music “.
    In the experiment the article describes, the only people who really stop to listen are the ones who were taught music – they had the language. If I walk past people talking Russian I wouldn’t be aware of them, but if I walk past people speaking Malay I will be eavesdropping before I’m aware I’m listening. I think children should be given the opportunity to learn that musical language (as well as another language or two).

    Conrad – mental problems could be caused by many things – probably the fact that more and more people live alone is related to it, but I think one of the reasons is a lack of meaning, context, history. Do you notice what has happened to Easter – once a day for reflection on the fact that you and everyone you will ever love will die, then the waiting, then the unrecognisable, transformed life – now it’s transformed by commercial sport, shopping etc. Without an occasion, a structure, a story to help us deal with ‘life’ people will find themselves in a hard place when trouble strikes. Our cultural history can provide those stories and experiences – they’ve lasted over generations (amongst the wealthier, educated classes) – I just think it would be a good thing to introduce more people to them.

  • 9
    conrad
    April 12th, 2007 13:56

    Excluding the living alone reason (supporting data exists for single males), thats very deep and historical Russell. However, I don’t see why commercial sport (your example) is any less good for people to worry about than [insert history here]. This is just elitism against commercial culture.
    Until someone provides some quantitative evidence of the difference (which should be ridiculously easy to collect incidentally), I wouldn’t believe such a claim. A large part could be biological (for which there is evidence for some forms of mental disease) for all we know. As for the bit that is left over, the difference could be found simply by subtracting the incidence of those with cultured values versus those with commercial values.

  • 10
    Russell
    April 12th, 2007 15:23

    “elitism against commercial culture” No, it’s not. It’s not elitist and it’s not snobbish. I’m detecting some of the “we’re ocker and we’re proud of it” here. We all live in and enjoy popular culture.

    My example of the loss of traditional Easter reflection is about the increasing distraction by more superficial activities. It’s like a diet of chocolates, ice-cream, cake ….it’s not sustaining. (That reminds me, there’s an article in The West this morning abaout a study that shows that a quarter of teenagers eat fast food every day “while more than a third said they hardly ever ate fruit”. Commenting on two threads at once: food and clothes may seem cheaper, but good quality food and clothes aren’t.)

    Evidence – - how about the evidence that so many people you admire, over many generations, have thought that these cultural traditions were important to experience and hand on.

  • 11
    conrad
    April 12th, 2007 19:45

    Russell — I’m one of the least ocker people you can imagine. You might not know this, but I often complain about various aspects of Australian culture and its consequences. That includes many of the strangely deluded values that Australians have about themselves like egalitarianism, neighborhood values, mateship, being great Aussie inventors, and my pet hate, the Aussie larrikan. Sometimes I even think I should pick my ass up and move somewhere else again.

    Like I said before, the evidence should be easy to collect, so we don’t need to speculate about it. My bet is that if I go and collect a group of people that are into high culture as defined by Russell, they will shown no difference in their prevelance of mental disease comapared to their footy loving materialistic idiotic ocker compatriots.

  • 12
    Russell
    April 12th, 2007 20:43

    Conrad I think you might be right about mental disease; I was thinking about the term Andrew used “mental ill-being” – and even there I’m not sure they would suffer less of it. But as a steady diet of junk food won’t sustain your health in the long run, exposure to nothing but popular culture won’t sustain you through crises too well either.

    I’m not sure – most of the people I know grew up with a religious background, not a ‘cultural’ one, and it’ll be interesting to see what happens to the generations who grow up without that story. New enduring stories of depth might come along for them – ANZAC seems to be one that is being developed in popular culture.

  • 13
    Sacha Blumen
    April 12th, 2007 23:09

    Russell, I don’t understand your distinction between “popular culture” and other (less popular?) parts of culture. Basically by definition, “popular culture” is the culture(s) that many (most?) people do, but that’s about it. I imagine that Impressionist painting is part of popular culture, while Baroque music involving a harpiscord on continuo is more boutique, but I don’t understand why one is seemingly more worthy than the other.

    If you’ve never been exposed to (or educated about) impressionist painting or Baroque music employing a continuo, then either may seem odd or incomprehensible, but I don’t see what that has to do with anything. I saw indigeneous art from around the world in the new Museum of Indigeneous art in Paris last year (I forget the museum’s name) and large parts of the art was unusual to me (including some statues from western africa that looked as if they could have been depictions of two-legged aliens!), and while I’m glad that some people have some understanding of it, it’s personally fine for me to not necessarily understand it.

    It seems possibly that you’re saying that popular culture is of less value than non-popular culture. Why is something of less value just because it’s popular?

  • 14
    conrad
    April 13th, 2007 06:49

    Russell, you’re obviously very old or an exception to the norm on religious values.

    I also don’t know about your claim about ANZAC culture. Aside from the fact its beggining to sound like a Howardesque “Australians values” statement disguised as culture, I doubt many people really know or care much about ANZACs, which isn’t very surprising, since Australia’s war time contributions have been basically zero compared to many countries (cf. Gallipoli vs. 30 million dead Russians) — and that’s a good thing. In addition, even for those that do happen to know some of the history, a lot of the contributions seem to be excersizes in stupidity (like WWI, Vietnam, Iraq, Korea) and why should we celebrate that?

    I could complain further, but I won’t, but I think your example highlights what is wrong with taking some predefined cultural event and saying how Australian they are (especially if done by the government).

  • 15
    Club Troppo » Missing Link
    April 13th, 2007 10:03

    [...] a US context. Just to prove that he can apply his psephelogical skills to anything, Andrew Norton discusses recent data suggesting that we are becoming a more depressed nation, while Catallaxy’s Jason Soon [...]

  • 16
    Russell
    April 13th, 2007 11:27

    Sacha – it was too late to start this last night! and really I have to work today, but you ask a good question. I’m not sure what terms I should have used … maybe ‘entertainment culture”? This is a very big question. You could help by giving me points to bounce off, could you please address the topic: “Kylie or Callas, it’s all the same to me”

  • 17
    Russell
    April 13th, 2007 11:30

    “I doubt many people really know or care much about ANZACs, which isn’t very surprising, since Australia’s war time contributions have been basically zero compared to many countries (cf. Gallipoli vs. 30 million dead Russians” ouch! – there’s got to be a mental illness to do with counting things (economics?), anybody know the name of it ?

  • 18
    Swealounown
    November 16th, 2007 19:05

    Two new studies show why some people are more attractive for members of the opposite sex than others.

    The University of Florida, Florida State University found that physically attractive people almost instantly attract the attention of the interlocutor, sobesednitsy with them, literally, it is difficult to make eye. This conclusion was reached by a series of psychological experiments, which were determined by the people who believe in sending the first seconds after the acquaintance. Here, a curious feature: single, unmarried experimental preferred to look at the guys, beauty opposite sex, and family, people most often by representatives of their sex.

    The authors believe that this feature developed a behavior as a result of the evolution: a man trying to find a decent pair to acquire offspring. If this is resolved, he wondered potential rivals. Detailed information about this magazine will be published Journal of Personality and Social Psychology.

    In turn, a joint study of the Rockefeller University, Rockefeller University and Duke University, Duke University in North Carolina revealed that women are perceived differently by men smell. During experiments studied the perception of women one of the ingredients of male pheromone-androstenona smell, which is contained in urine or sweat.

    The results were startling: women are part of this repugnant odor, and the other part is very attractive, resembling the smell of vanilla, and the third group have not felt any smell. The authors argue that the reason is that the differences in the receptor responsible for the olfactory system, from different people are different.

    It has long been proven that mammals (including human) odor is one way of attracting the attention of representatives of the opposite sex. A detailed article about the journal Nature will publish.