Prevalence and statistics of mental illnesses

Mental health is currently one of the most serious problems facing all countries, with at least one in four people experiencing mental health problems at some point in their lives. The prevalence of mental health problems 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 suffer from alcohol use disorders; over 7 million have Alzheimer's disease and other types of dementia; about 4 million have schizophrenia; 4 million have bipolar affective disorders and 4 million have panic disorders.

Mental disorders are the second leading cause of disease burden after cardiovascular disease, accounting for 19.5% of all disability-adjusted life years (DALYs). Depression, the third leading cause, accounts for 6.2% of all DALYs. Self-harm, the eleventh leading cause of DALYs, accounts for 2.2%, and Alzheimer's disease and other dementias, the fourteenth leading cause, accounts for 1.9% of DALYs. As the population ages, the number of people with such disorders is likely to increase.

Mental disorders also account for more than 40% of all chronic diseases. They are a significant cause of healthy years of life lost due to disability. The most important single cause is depression. Five of the fifteen leading factors influencing the burden of disease are mental disorders. In many countries, 35-45% of absenteeism from work is due to mental health problems.

One of the most tragic consequences of mental disorders is suicide. Nine out of ten countries in the world with the highest suicide rates are located in the European region. According to the latest data, about 150,000 people commit suicide every year, 80% of them are men. Suicide is the leading and hidden cause of death among young people, ranking second in the 15-35 age group (after road traffic accidents).

In 2001, V.G. Rotstein and co-authors proposed combining all mental disorders into three groups, differing in severity, nature and duration of the course, and risk of relapse.

1. Disorders that require patients to be under psychiatric observation throughout their lives: chronic psychoses; paroxysmal psychoses with frequent attacks and a tendency to become continuous: chronic non-psychotic conditions (sluggish schizophrenia and similar conditions, diagnosed as "schizotypal disorder" or "mature personality disorder" in the ICD-10) without a tendency to stabilize the process with satisfactory social adaptation; dementia; moderate and severe forms of mental retardation.
2. Disorders requiring observation during 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 stabilization of the process with satisfactory social adaptation; relatively mild variants of oligophrenia; neurotic and somatoform disorders; mild affective disorders (cyclothymia, dysthymia); post-traumatic stress disorder.
3. Disorders that require observation only during the acute phase: acute exogenous (including psychogenic) psychoses, reactions and adaptation disorders.

Having defined the contingent of patients in need of psychiatric care, V. G. Rotshteyn et al. (2001) found that about 14% of the country's population needs real help from mental health services. While, according to official statistics, only 2.5% receive this help. In this regard, an important task for organizing psychiatric care is to determine the structure of care. It 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 volumes of care.

The number of patients in need of help is a new indicator, the "current number of mentally ill". Determining this indicator should be the first task of an applied epidemiological study aimed at improving psychiatric care. The second task is to obtain a basis for improving treatment and diagnostic programs, planning the development of psychiatric services, calculating the personnel, funds and other resources needed for this on the basis of the "current number of mentally ill", as well as on the basis of studying the clinical structure of the corresponding contingent.

When attempting to estimate the "current number of patients" in a population, it is necessary to decide which of the commonly used indicators is most adequate. Selecting a single indicator for all mental health disorders is unjustified. Each group of disorders that includes cases similar in severity, course, and risk of relapse should use its own indicator.

Taking into account the characteristics of the selected groups, the following indicators are proposed to determine the “current number of persons with mental disorders”: lifetime 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 individuals who have experienced the disorder at some point in their lives.
• For patients in the third group, year prevalence reproduces the number of individuals who have had the disorder over the past year.
• For patients with 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 made it possible 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, this period determines the duration of the active period of the disease. For practical purposes, this period is excessively long (it is 25-30 years). At present, active dispensary observation is stopped if the duration of remission in paroxysmal schizophrenia is 5 years. Taking into account 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, one can choose the prevalence over the past 10 years (10-year prevalence) as a satisfactory indicator for it.

To estimate the current number of people with mental disorders, it was necessary to have an adequate estimate of the total number of people with mental health disorders in the population. Such studies led to two main results.

• It has been proven that the number of sick people in the population is many times greater than the number of patients in psychiatric services.
• It has been established that no surveys can identify all patients in the country, so their full number can only be obtained through theoretical assessment. The material for this is current statistics, the results of specific epidemiological studies, etc.

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Prevalence of mental illness in Russia

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

• The first (main) pattern is that the prevalence rates of all mental illnesses in Russia have increased 10-fold over the past 45 years.
• The second pattern is a relatively low level and insignificant growth in the prevalence of psychoses (mental or psychotic disorders proper: an increase of only 3.8 times over the entire 20th century, or from 7.4 cases per 1,000 people in 1900-1929 to 28.3 in 1970-1995). The highest prevalence levels and growth rates are characteristic of neuroses (increased by 61.7 times, or from 2.4 to 148.1 cases per 1,000 people) and alcoholism (increased by 58.2 times, or from 0.6 to 34.9 cases per 1,000 people).
• The third pattern is high growth rates of the prevalence of mental retardation (30 times, or from 0.9 to 27 cases per 1,000 people) and senile psychosis (20 times, or from 0.4 to 7.9-8 cases).
• The fourth pattern is that the greatest increase in the prevalence of mental pathology was noted in 1956-1969. For example: 1900-1929 - 30.4 cases per 1,000 people; 1930-1940 - 42.1 cases; 1941-1955 - 66.2 cases; 1956-1969 - 108.7 cases and 1970-1995 - 305.1 cases.
• The fifth pattern is the virtually identical prevalence of mental illnesses in both economically developed Western countries and the Union of Soviet Socialist Republics (growth in 1930-1995 by 7.2 and 8 times). This pattern reflects the universal human nature 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 WHO experts, are the increase in population density, urbanization, destruction of the natural environment, the complication of production and educational technologies, an avalanche-like increase in information pressure, an increase in the frequency of emergency situations (ES), deterioration of physical health, including reproductive health, an increase in the number of head injuries and birth injuries, and the intensive aging of the population.

The above reasons are fully relevant for Russia. The crisis state of society, abrupt economic changes with a decrease in the standard of living of people, a change in values and ideological ideas, interethnic conflicts, natural and man-made disasters causing population migration, the breakdown of life stereotypes significantly affect the mental state of members of society, give rise to stress, frustration, anxiety, a sense of insecurity, depression.

Closely related to these are socio-cultural trends that impact mental health, such as:

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

Mental health is one of the parameters of the population's condition. It is generally accepted to assess the state of mental health by indicators characterizing the prevalence of mental disorders. Our analysis of some socially significant indicators allowed us to identify a number of features of their dynamics (according to data on the number of patients who applied to outpatient psychiatric institutions of the Russian Federation in 1995-2005).

• According to statistical reports from medical and preventive institutions in the Russian Federation, the total number of patients seeking psychiatric care increased from 3.7 to 4.2 million people (by 13.8%); the overall incidence rate of mental disorders increased from 2502.3 to 2967.5 per 100 thousand people (by 18.6%). The number of patients diagnosed with a mental disorder for the first time in their lives also increased in approximately the same proportions: from 491.5 to 552.8 thousand people (by 12.5%). The primary incidence rate increased over 10 years from 331.3 to 388.4 per 100 thousand people (by 17.2%).
• At the same time, there were quite significant shifts in the structure of patients according to individual social characteristics. Thus, the number of people of working age suffering from mental disorders increased from 1.8 to 2.2 million people (by 22.8%), and per 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 employed mentally ill people decreased from 884.7 to 763.0 thousand people (by 13.7%), and the indicator of the number of employed mentally ill people decreased from 596.6 to 536.1 per 100 thousand people (by 10.1%).
• The number of patients with mental disabilities increased significantly during the specified period: from 725.0 to 989.4 thousand people (by 36.5%), i.e. in 2005, almost every fourth patient in the total number of patients was mentally disabled. The number of disabled people per 100 thousand people increased from 488.9 to 695.1 (by 42.2%). At the same time, the decrease in the indicator of primary disability due to mental illness that began in 1999 was interrupted in 2005; it began to increase again and amounted to 38.4 per 100 thousand people in 2005. The share of working disabled people fell from 6.1 to 4.1%. The share of children in the total number of mentally ill people recognized as disabled for the first time in their lives increased from 25.5 to 28.4%.
• With a fairly moderate increase in the total number of mentally ill patients, the number of hospitalized patients increased slightly. In absolute terms: from 659.9 to 664.4 thousand people (by 0.7%), and per 100 thousand people - from 444.7 to 466.8 (by 5.0%). At the same time, the increase in the number of hospitalized patients occurred exclusively due to patients with non-psychotic mental disorders.
• The number of mentally ill people committing socially dangerous acts has increased: from 31,065 in 1995 to 42,450 in 2005 (by 36.6%).

Thus, from 1995 to 2005, with a moderate increase in the total number of patients with mental disorders who sought specialized help, there was a “growth” of the contingent of patients: both due to a significant increase in the number of patients with disabilities due to mental illness, and due to a significant reduction in the number of employed mentally ill patients.