Prevalence and statistics of mental illnesses

Currently, mental health is one of the most serious problems facing all countries, since at any given period of life such problems arise at least for every fourth person. The prevalence of mental health disorders in the European Region is very high. According to WHO (2006), of the 870 million people living in the European Region, about 100 million experience anxiety and depression; over 21 million people suffer from alcohol-related disorders; more than 7 million - Alzheimer's disease and other types of dementia; about 4 million - schizophrenia; 4 million - bipolar affective disorders and 4 million - panic disorders.

Mental disorders - the second (after cardiovascular diseases) is the cause of the burden of disease. They account for 19.5% of all life years lost as a result of disability (DALYs are years of life lost due to illness and premature death). Depression, the third most important reason, belongs to 6.2% of all DALYs. The share of self-harm, the eleventh-most important cause of DALYs, is 2.2%, and for Alzheimer's and other dementias, which rank fourteenth in the list of causes, 1.9% of DALYs. As the population ages, the number of people with such disabilities will apparently increase.

Mental disorders also account for more than 40% of all chronic diseases. They are a weighty reason for the loss of healthy years of life due to disability. The most important single cause is depression. Five of the fifteen major factors that affect the burden of disease are among the mental disorders. In many countries, 35-45% of absenteeism is associated with mental health problems.

One of the most tragic consequences of mental disorders is suicide. Nine out of ten countries with the highest suicide rates are located in the European Region. According to the latest data, about 150,000 people voluntarily leave their lives annually, 80% of them are men. Suicide is the leading and hidden cause of death among young people, it ranks second in the age group of 15-35 years (after road accidents).

V.G. Rothstein et al. In 2001, proposed to combine all mental disorders into three groups, varying in severity, nature and duration of the course, the risk of relapse.

1. Disorders that force patients to be monitored by a psychiatrist throughout their lives: chronically occurring psychoses; paroxysmal psychoses with frequent seizures and a tendency to transition to a continuous course: chronic nonpsychotic conditions (sluggish schizophrenia and related conditions within ICD-10 diagnosed as "schizotypic disorder" or "mature personality disorder") without a tendency to stabilize the process with satisfactory social adaptation; the state of dementia; moderate and severe options for mental retardation.
2. Disorders requiring observation in the active period of the disease; paroxysmal psychoses with the formation of long-term remission; chronic non-psychotic conditions (sluggish schizophrenia, psychopathy) with a tendency to stabilize the process with satisfactory social adaptation; relatively easy variants of oligophrenia; neurotic and somatoform disorders; poorly expressed affective disorders (cyclothymia, dysthymia); AKP.
3. Disorders requiring observation only during the acute period: acute exogenous (including psychogenic) psychoses, reactions and adaptation disorders.

Having determined the contingent of people in need of psychiatric care, V.G. Rothstein et al. (2001) found that about 14% of the country's population needed real help from mental health services. While, according to official statistics, only 2.5% get this help. In this regard, an important task for the organization of psychiatric care - the definition of the structure of care. She must have reliable data on the true number of people in need of psychiatric care, on the socio-demographic and clinical-epidemiological structure of these contingents, giving an idea of the types and amounts of assistance.

The number of patients in need of care is a new indicator, "the actual number of mentally ill people". The definition of this indicator should be the first applied task aimed at improving the psychiatric care of epidemiological research. The second task - on the basis of the "actual number of mentally ill", and also on the basis of the study of the clinical structure of the relevant contingent, to obtain a basis for the improvement of therapeutic and diagnostic programs, planning the development of psychiatric services, calculating the necessary staff, money and other resources.

When trying to evaluate the "actual number of patients" in the population, it is necessary to decide which of the commonly used indicators is most appropriate. The choice of one indicator for all mental health disorders is illegal. For each group of disorders, combining cases that are similar in severity, the nature of the course and the risk of relapse, its indicator should be used.

Given the characteristics of the selected groups to determine the "current number of people with mental disorders" are proposed indicators; life prevalence, year prevalence, point prevalence, reflecting the number of persons suffering from this disorder at the time of the survey.

• For patients in the first group, life prevalence reflects the number of people who experienced this disorder ever during life.
• For patients in the third group, the year prevalence reproduces the number of individuals who have had a disorder in the past year.
• For patients of the second group of disorders, the choice of an adequate indicator is less obvious. Prytovoy E.B. Et al. (1991) conducted a study of patients with schizophrenia, which allowed to determine the period of time after which the risk of a new attack of the disease becomes the same as the risk of a new case of the disease. Theoretically, such a period determines the duration of the active period of the disease. For practical purposes, this period is prohibitively large (it is 25-30 years). Currently active dispensary observation is terminated if the duration of remission in case of seizure schizophrenia is 5 years. Given the above, as well as the experience of psychiatric institutions in the duration of observation of patients with other (non-schizophrenic) disorders included in the second group, it can be chosen as a satisfactory indicator for it prevalence over the last 10 years (10-year prevalence).

To assess the actual number of people with mental disorders, an adequate assessment of the total number of people with mental health disorders in the population was needed. Such studies led to two main results.

• It is proved that the number of patients in the population is many times greater than the number of patients in psychiatric services.
• It is established that no surveys can identify all patients in the country, so the total number can be obtained only through a theoretical evaluation. The material for this is the data of current statistics, the results of specific epidemiological studies, etc.

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The prevalence of mental illness in Russia

Analyzing WHO materials, national statistical and clinical epidemiological materials, O.I. Shchepin in 1998 revealed trends and patterns of the spread of mental illness in the Russian Federation.

• The first (main) regularity - the prevalence rates in Russia of all mental illnesses for the past 45 years have grown 10 times.
• The second pattern is a relatively low level and a slight increase in the prevalence of psychosis (actually mental or psychotic disorders: an increase of only 3.8 times over the entire 20th century, or from 7.4 cases per thousand people in 1900-1929 to 28, 3 in 1970-1995). The highest prevalence rates and growth rates are characteristic for neuroses (increased 61.7 times, or 2.4 to 148.1 cases per thousand people) and alcoholism (increased 58.2 times, or 0.6 to 34.9 cases per thousand people).
• The third pattern is the high rates of growth in the prevalence of mental underdevelopment (30 times, or 0.9 to 27 cases per thousand people) and senile psychoses (20 times or 0.4 to 7.9-8 cases) .
• The fourth regularity - the greatest increase in the prevalence of mental pathology was noted in 1956-1969. For example: 1900-1929 years. - 30.4 cases per thousand people. 1930-1940 - 42.1 cases; 1941-1955 - 66.2 cases; 1956-1969 - 108.7 cases and 1970-1995 - 305.1 cases.
• The fifth regularity is in fact the same level of prevalence of mental illnesses both in the economically developed countries of the West and in the Union of Soviet Socialist Republics (an increase of 7.2 and 8 times in the 1930-1995 period). This pattern reflects the universal essence of mental pathology, regardless of the socio-political structure of society.

The main reasons for the increase in the number of mental disorders in the modern world, according to experts from WHO, are an increase in population density, urbanization, the destruction of the natural environment, the complication of production and educational technologies, an avalanche-like information pressure, an increase in the incidence of emergencies. Deterioration of physical health. Including reproductive, an increase in the number of brain injuries and birth injuries, and an intensive aging of the population.

The above reasons are fully relevant for Russia. The crisis state of society, sharp economic changes with a decrease in people's living standards, the changing values and ideological representations, interethnic conflicts, natural and man-made disasters that cause migration of the population, the breakdown of life stereotypes have a significant impact on the mental state of members of society, generate stress, frustration, feeling of uncertainty, depression.

In close connection with them - socio-cultural trends affecting mental health, such as:

• weakening of family and neighbor ties and mutual assistance;
• feeling of alienation from state power and the management system;
• increasing material needs of a consumer-minded society;
• the spread of sexual freedom;
• a rapid increase in social and geographical mobility.

Mental health is one of the parameters of the state of the population. It is generally accepted to assess the state of mental health in terms of indicators characterizing the prevalence of mental disorders. Our analysis of some socially significant indicators made it possible to reveal a number of features of their dynamics (according to data on the number of patients who turned to out-of-hospital psychiatric services in 1995-2005).

• According to statistical reports of medical and prophylactic institutions of the Russian Federation, the total number of patients who applied for psychiatric care increased from 3.7 to 4.2 million people (by 13.8%); The indicator of the general incidence of mental disorders increased from 2502.3 to 2967.5 per 100,000 people (by 18.6%). Approximately in the same proportions, the number of patients who for the first time in their lives was diagnosed with a mental disorder increased from 491.5 to 552.8 thousand people (by 12.5%). The indicator of primary morbidity increased over 10 years from 331.3 to 388.4 per 100 thousand of the population (by 17.2%).
• At the same time, significant changes occurred in the structure of patients on certain social grounds. Thus, the number of people of working age with mental disorders increased from 1.8 to 2.2 million people (by 22.8%), and in the number of 100 thousand people the number of such patients increased from 1209.2 to 1546.8 (by 27.9%). In the same period, however, the absolute number of working mentally ill patients decreased from 884.7 to 763.0 thousand people (by 13.7%), and the number of working mentally ill patients decreased from 596.6 to 536.1 per 100 thousand of the population (by 10.1%).
• The number of patients with mental disabilities increased significantly from 725.0 to 989.4 thousand people (by 36.5%), that is, significantly higher. In 2005 in the contingent of all patients almost one in four was disabled in mental illness. In the calculation for 100 thousand people the number of disabled persons increased from 488.9 to 695.1 (by 42.2%). At the same time, the decrease in the rate of primary access to disability for mental illness that began in 1999 was interrupted, it again began to increase and amounted to 38.4 per 100,000 people in 2005. The share of disabled workers fell from 6.1 to 4.1%. The share of children in the total number of mentally ill persons, for the first time recognized as disabled, increased from 25.5 to 28.4%.
• With a fairly moderate increase in the total number of mentally ill, the contingent of hospitalized patients has slightly increased. In absolute terms: from 659.9 to 664.4 thousand people (by 0.7%), and in terms of 100 thousand people - from 444.7 to 466.8 (5.0%). At the same time, the increase in the number of hospitalized patients occurred solely at the expense of patients with nonpsychotic psychiatric disorders.
• The number of mentally ill people committing socially dangerous actions has grown: from 31,065 in 1995 to 42,450 in 2005 (by 36.6%).

Thus, for 1995-2005, with a moderate increase in the total number of patients with mental disorders seeking specialized care, there was a "weighting" of the contingent of patients: due to a significant increase in the number of patients with mental disabilities, and due to a significant reduction in the number of employees mentally ill.