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Psychological
disorders are causing 1.3 billion sick days
(January
2008 Issue)
By Pamela Berard
Approximately one-third of sick days are caused by psychological
disorders, according to a survey sponsored by the National Institute
of Mental Health.
The survey of more than 9,000 adults was based on the National
Comorbidity Survey-Replication and measured sick days for chronic
conditions. Adults with mental disorders - including depression
and anxiety - miss 1.3 billion days of work, school or other activities
every year, more than back and neck pain, which caused 1.2 billion
days per year, according to the survey. Americans report 3.7 billion
sick days a year because of chronic conditions such as cancer, vision
loss and heart attacks.
Researchers say some of the impairment could be eradicated if more
emphasis was put on treating and recognizing psychological disorders.
Senior author Ronald C. Kessler, Ph.D., a professor of healthcare
policy at Harvard Medical School, says there have been a lot of
studies in the past that looked at the cost of schizophrenia or
depression or other disorders individually, but this study is unique
in that it took a comprehensive look at psychological disorders
nationwide.
The study was also unique because it took a comparative perspective
of physical disorders and psychological disorders, he says. "It
was a surprise to see how enormous (the number of sick days) was
for mental health disorders." The fact that one out of every three
days is because of a mental disorder is "extraordinary," he says.
That number is particularly noteworthy if one analyzes another
factor. "If I look at how much money is given on research to cancer
or heart disease or diabetes, obviously the allocation of resources
to tackle these problems are way out of kilter with the magnitude
of these problems," Kessler says. "Mental health disorder is not
getting the attention it deserves."
That is not only true for research, but also true for treatment.
"When we look at some other work we've done on patterns of treatment
for mental and physical disorders, we find that, in general, people
are more likely to get treatment for a physical than a mental health
problem for comparable severity," he says.
"There are two reasons," Kessler continues. "One is that people
don't very often code emotional distress as an illness." He notes
that one of the lowest rates of treatment is for social phobia or
anxiety. "People say, 'I'm shy … it's not an illness.'"
Likewise, people who are chronically depressed might rationalize
that there is nothing wrong with them - the world is just a terrible
place.
Another reason people don't seek help for an emotional impairment
is fear of stigma and embarrassment. People worry that maybe they
"won't get the promotion," he says.
Public perception is a factor. "People say, you 'have' a heart
attack, but you 'are' mentally ill," Kessler adds.
According to the study, more than half of Americans have chronic
health conditions, which result in an average of 32 sick days annually.
Of the 1.3 billion sick days for mental health disorders, depression
topped the list with 387 million. Social phobia accounted for 214
million; posttraumatic stress disorder, 113 million; generalized
anxiety disorder, 110 million; and bipolar disorder and panic disorders
were each just over 100 million. Other issues included substance
abuse, agoraphobia and separation anxiety disorder.
Physical conditions that resulted in sick days included arthritis
(375 million), stroke (221 million), heart attack (204 million)
and cancer (71.5 million).
Public awareness of mental health conditions is rising, Kessler
says, but still, there is a misallocation of attention and funds
in medicine in general. "It's not just mental disorders. If you
look at the amount of research money available for childhood cancer,
it's staggering in relation to the number of kids who have cancer,"
he says. "The reason is, it's just a compelling thing."
"It's hard to know what the right allocation for formulas is,"
Kessler says. "But we know there are an awful lot of people with
mental disorders who are suffering and are not in treatment compared
to people with less severe physical disorders who are getting treatment."
The allocation needs to be changed, "to make society as a whole
function better," he says.
Lead author for the study was Kathleen Merikangas, an epidemiologist
with the National Institute of Mental Health.
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