Below are descriptions of symptoms and treatments of common mental health disorders. Individuals may not have all symptoms of a specific disorder or symptoms of several disorders. The latter is called comorbidity. It is common to have features of several anxiety disorders. A high level of anxiety over a long time will often lead to depression, so that many people have a mixture of anxiety and depression. People with anxiety disorders frequently use substances as form of self-medication to help cope. This can lead to substance use problems. Furthermore, heavy use of alcohol and drugs can lead to increased anxiety. However, comorbidity does not necessarily imply the presence of multiple disorders but could also reflect the current inability to supply a single diagnosis accounting for all symptoms (22,23).
Mental health disorders are typically not caused by single factors but potential adverse and protective factors have been identified (1).
Image source: https://ourworldindata.org/mental-health#risk-factors-for-mental-health
Common mental health disorders
The following information about mental health disorders has been summarized from the ensa Mental Health First Aid manual (www.ensa.swiss). Copyright of ensa and the Swiss Foundation Pro Mente Sana, Zurich. The information about (complex) post-traumatic stress disorder is from 28, 29.
Prevalence of mental health disorders
Conservative estimate for high-income countries (11):
more than 1 in 6 people have a mental health disorder in any given year
more than 1 in 3 people have a mental health disorder during lifetime
Since mental health disorders are stigmatized, there is likely an underreporting and under-diagnosis of mental health disorder (19). Indeed people with a diagnosed mental health disorder are stigmatized in every country, society or culture (18). Furthermore, more money is spend on healthcare in high-income countries than in middle- or low-income countries. This has an impact of the number for diagnosed mental health disorders. Global values of mental health disorder prevalence (19) therefore likely underestimate the true prevalence of mental health disorders.
Best estimate for high-income countries (8,20,21):
1 in 5 people have a mental health disorder in any given year
1 in 20 people have a severe mental disorder in any given year
1 in 2 people have a mental health disorder during lifetime
The prevalence of mental health disorders has not significantly changed over time (at least since 1990) (19).
A large percentage of people with mental health disorders that would need professional treatment do not seek help (2). This has been called treatment gap. Furthermore not everyone seeking help receives adequate treatment (=treatment by a specialist e.g. psychiatrist, psychotherapist, psychologist, psychoanalyst) (3). The main reason for the treatment gap is stigmatization of mental health, causing unnecessary, additional suffering (3).
Table source: Barbato et al. (2014). Access to Mental Health Care in Europe.
Efficacy of treatments
Various meta-analysis show an effect size of 0.80 (0.75 to 0.85) of psychotherapy (4). Compared to other therapy types of common health problems, that's an effective treatment (5). Rosenzweig’s (6) speculation: “All methods of psychotherapy when competently used are equally successful” still holds (4).
Image source: Leucht et al. (2015) How effective are common medications: a perspective based on meta-analyses of major drugs, BMC Medicine, https://doi.org/10.1186/s12916-015-0494-1
Average duration of psychotherapy
There is empirical data showing how many sessions (typical length of 45-60 minutes per session) it will take for people to feel reliable improvements (appreciable benefits) and for full recovery (indistinguishable from 'normal' peers) (25,26,27):
- Length of treatment varies and depends on nature and severity of disorder (e.g. acute or chronic)
- About 20 sessions for 50% of patients to fully recover (8 sessions for appreciable benefits)
- More than 50 sessions for 75% of patients to fully recover (14 sessions for appreciable benefits)
- Longer treatment for patients with co-occuring conditions or certain personality difficulties
- The average duration of psychotherapy in Switzerland is 29 sessions
Stigmatization and discrimination of people who have an illness is not a new phenomenon. Historical examples are stigmatization of people with leprosy, cholera or yellow fever and in more recent times, HIV/AIDS or tuberculosis (7). This has caused a lot of unnecessary and additional suffering. It is time to learn from the past and to not make the same mistakes over and over again. Stigmatization and discrimination cause directly and indirectly a burden on mental health (the stigmatization of mental health problems has therefore been called a second disease). A big problem caused by stigmatization of mental health is the treatment gap (2,3). Due to the general lack of knowledge about mental health disorders and false assumptions about the disorders and treatment options, people often do not seek adequate professional help or do so only at a late stage after years of suffering (see above). There are further problems caused by stigmatization of mental health problems, some of which are similar to other forms of discrimination.
Situation in academia
Academics have been found to be among the occupational groups with the highest levels of common mental disorders (13). For example 41%/39% of graduate students have moderate to severe symptoms of anxiety/depression (14) compared to 14%/8% in the general population (for the situation in Switzerland see 15,16). For other groups e.g. postdocs there is a lack of epidemiological data. One of the underlying causes for stressors in academia is that there are not enough full-time academic posts. Some ideas to improve the situation are (17):
Enhanced access to mental health support
Cultural change (train the trainers, communicate openly about mental illnesses, work-life balance)
Studies on the effectiveness on interventions are needed
Reform PhD+Postdoc system