August 27, 2004

Bipolar Disorder Lacking in Services

World Health Organization Study Results

A survey by the World Health Organization shows that in most parts of the world, people with the most serious mental health problems -- including Bipolar Disorder -- are not getting the treatment they need.

A standard interview was used to diagnose more than 60,000 people in eight developed and six less developed countries, including the United States, Canada, and several European and Latin American nations, as well as Lebanon, Nigeria, Japan, and China. The questions covered anxiety and mood disorders, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, drug dependence, and alcoholism.

A special feature of this survey was a question about severity. Mental illness was defined as severe if it involved bipolar (manic-depressive) disorder, physical dependence on drugs or alcohol, a suicide attempt, or any disorder that had interfered with everyday activities for a month or more in the previous year.

The rate of mental disorders varied extraordinarily widely, from 4% of people interviewed in China to 26% of those interviewed in the United States. Anxiety and mood disorders were most common.

The proportion of people with a serious psychiatric disorder ranged from under 1% to nearly 8% in various countries. The proportion of psychiatric disorders described as mild also varied greatly, from 33% in Colombia to a high of 81% in Nigeria.

The survey had some deficiencies. Its estimates of mental illness were probably low because people with psychiatric disorders are less likely to participate in surveys. The response rate was different in different countries, and the interview might not have worked well in some places because of reluctance to admit serious emotional problems. That could explain why, in countries with surprisingly low rates of acknowledged severe mental illness, a high proportion of patients admitted seeking help for supposedly mild symptoms.

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