Mental Health Disorders in the United States

The United Nations included Non-Communicable Diseases (NCDs) in its Sustainable Development Goals (SDGs) (specifically, SDG 3, Ensure healthy lives and promote well-being for all at all ages).1  Often referred to as the NCD4, the four non-communicable diseases articulated in early drafts of the SDGs were: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.2  By the time the SDGs were finally adopted, however, the focus on the NCD4 was eventually broadened to include mental disorders.3

Many people have more than one NCD, but comorbidity between mental health disorders and other NCDs is especially high.  Early-onset mental illnesses may correlate to heart disease in adults.3  In the United States, people with depression are 40% more likely than the general population to develop cardiovascular disease and those with serious mental illness are 200% more at risk.Diabetes is significantly linked to schizophrenia, depression, eating disorders, and bipolar disorders.  There are links between certain cancers and anxiety, depression, and post-traumatic stress disorders and, according to the World Mental Health Survey, mood disorders and substance abuse are associated with adult-onset asthma.3

According to the World Health Organization (WHO), the United States has the highest rate of mental health disorders of any country in the world.  Every year 27% of adults5 and one in six children4 experience a mental health disorder.  And this estimate is a conservative one as WHO’s assessment excludes schizophrenia, personality disorders, and eating disorders – nearly 15% of people in the U.S. suffers from one of these afflictions.5

So what are the factors driving the unusually high rates of mental health disorders in the U.S.?  There are numerous data points and theories.  Sociologists have noted that across multiple demographics, there has been a “long-term malaise”, or an increase in such measures as mistrust and loneliness over the past few decades.  Some hypothesise chronic stress, increased mechanisation, industrial chemicals, decrease in the quality of the food supply, and isolation due to more screen time and private automobile travel.6  Some researchers have called depression a “luxury disorder”, observing that people in less-developed countries tend to be less depressed,5 while others see a correlation between greater income inequality and higher rates of mental disorders.6

People are also less likely to be treated for mental disorders than for physical illnesses in the U.S.  In fact, only 41% of people with mental health disorders receive treatment.5  The high cost of medical insurance and treatment could be at fault.  (The United States expends more per capita on health care than any other country in the world and more than twice as much per person than Switzerland, the next highest spender.)6  Most people in the U.S. receive their health insurance coverage through their employer and since mental health disorders are the leading cause of disability in people under age 65, those afflicted may have even less access to health care.7  People with mental conditions also might have more difficulty accessing care because the behavioural mindset needed to seek treatment is out of reach to those suffering an acute mental illness.  Many may also resist support because they feel that either the mental health disorder itself, or the seeking of treatment is stigmatised.3

There is obviously a large social detriment to mental disease; however, there is also a very high economic cost.  Researchers from the World Economic Forum released a study last year on the macroeconomic burden to the U.S., which found that mental health conditions have the highest burden on economic productivity of any NCD.  This study estimates that between 2015-2050, mental health disorders (adjusted for comorbidity) will cost the U.S. economy, in terms of lost GDP, US$18.1 trillion (in 2010 USD).7  This trend could conceivably create a vicious cycle as the high cost of medical treatment not only impacts the present economy, but also takes away from other societal investments, which would be needed to combat drivers of mental health disorders.

 

1 United Nations (2019) Sustainable Development Goal 3 [online]. Sustainable Development Goals Knowledge Platform. Available from: https://sustainabledevelopment.un.org/sdg3 [Accessed 1 October 2019].

2 Anon (2018) NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. The Lancet, 392 (10152): 1072-1088

3 Stein, S., Benjet, C., Gureje, O., Lund, C., Scott, K., Poznyak, V. & van Ommeren, M. (2019) Integrating mental health with other non-communicable diseases. The BMJ, 2019, 364:1295 https://doi.org/10.1136/bmj.l295

4 National Alliance on Mental Illness (2019) Mental Health by the Numbers [online]. Available from: https://www.nami.org/learn-more/mental-health-by-the-numbers [Accessed 2 October 2019]

5 Walton, A. (2011) Why More Americans Suffer From Mental Disorders Than Anyone. The Atlantic. Available from: https://www.theatlantic.com/health/archive/2011/10/why-more-americans-suffer-from-mental-disorders-than-anyone-else/246035/ [ Accessed 2 October 2019]

6 Muennig, P., Reynolds, M., Fink, D., Zafari, Z. & Geronimus, A.T. (2018) America’s Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem. American Journal of Public Health, 108:1626-1631.

7 Chen, S., Kuhn, M., Prettner, K., Bloom, D.E. (2008) The macroeconomic burden of noncommunicable diseases in the United States: Estimates and projections. PLoS ONE 13(11): e0203702. https://doi.org/10.1371/journal.pone.0206702.

Increase in vector-borne diseases in the United States

In the United States, certain illnesses are appearing and increasing as climate change expands the range of disease-carrying insects, according to a recent article in National Geographic.

Twenty years ago, there were no reported cases of the mosquito-borne West Nile virus; since then there have been more than 41,000 instances reported.  The U.S. Center for Disease Control and Prevention (CDC) expects other mosquito-borne diseases such as Rift Valley fever and chikungunya to show up soon.  Incidents of tick-borne diseases – mostly Lyme disease and Rocky Mountain spotted fever – have doubled over the past 20 years.  “Kissing bugs” (Triatominae), which earn their name from biting humans near the mouth, carry the parasite Trypanosoma cruzi, the cause of Chagas disease, classified as a Neglected Tropical Disease (NTD) by the World Health Organisation.  Usually found in Central and South America, since 2013 doctors have begun to detect Chagas disease in the southern U.S.  There is no vaccine, notes a representative of the CDC, for any of these vector-borne diseases and occurrence of infection is only expected to increase.

In the case of ticks and kissing bugs, climate change is not the only reason for the proliferation of infection.  Deer are a common host for ticks carrying Lyme disease and deer populations have grown dramatically due to human development and loss of predators.  The article quotes a CDC researcher who says kissing bugs are also moving north into the U.S. because of “deforestation and destabilization through conflict” in their home ranges.  This same researcher, however, cautions that some of these diseases may be appear prevalent because of better detection techniques in the medical field.

The phenomenon of increased vector-borne diseases in the United States intersects with three of the Sustainable Development Goals (SDGs) contemplated in this week’s readings: SDG #3, Ensure healthy lives and promote well-being for all at all ages; SDG #13, Take urgent action to combat climate change and its impacts; and SDG #15, Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss.

Further research seemed outside the scope of this blog post, but I am intrigued to know how these diseases are expected to spread in the U.S.  Are the dispersal patterns simply based on weather and land use, or will they appear more in lower-income density areas?  I do know that much of the land use change that is leading to the proliferation of deer populations, and therefore certain ticks, is deforestation for development of suburban homes, which leads me to expect that the diseases carried by these ticks would affect more people in the middle class.

Another question that arises for me is whether there will be a more global effect from having NTDs surfacing in the U.S.  For example, will more attention be paid to them?  Would that lead to the development of vaccines and medications?  And would these treatments be made readily available in lesser developed countries?

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