Study paints somber picture of US mental health status and access to care
More Americans than ever before suffer from serious psychological distress, and the country's ability to meet the growing demand for mental health services is rapidly eroding.
Researchers from NYU Langone Medical Center analyzed a federal health information database and concluded that 3.4 percent of the U.S. population (more than 8.3 million) adult Americans suffer from serious psychological distress, or SPD.
According to the U.S. Centers for Disease Control and Prevention (CDC), which conducts the National Health Interview Survey on which the research is based, SPD combines feelings of sadness, worthlessness, and restlessness that are hazardous enough to impair people's physical well-being. Previous survey estimates had put the number of Americans suffering from SPD at 3 percent or less.
The findings — believed to be the first analysis of its kind in more than a decade — were published in the journal Psychiatric Services online April 17. More than 35,000 U.S. households, involving more than 200,000 Americans between the ages of 18 and 64, in all states and across all ethnic and socioeconomic groups, participate in the yearly survey.
Among the study's other key findings is that, over the course of the surveys from 2006 to 2014, access to health care services deteriorated for people suffering from severe distress when compared to those who did not report SPD.
"Although our analysis does not give concrete reasons why mental health services are diminishing, it could be from shortages in professional help, increased costs of care not covered by insurance, the great recession, and other reasons worthy of further investigation," says lead study investigator Judith Weissman, PhD, JD, a research manager in the Department of Medicine at NYU Langone.
Weissman says the situation appears to have worsened even though the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act (ACA) include provisions designed to help reduce insurance coverage disparities for people with mental health issues. She adds that the new report can serve as a baseline for evaluating the impact of the ACA and in identifying disparities in treating the mentally ill.
Comparing self-reported SPD symptoms across nine years, the NYU Langone research team estimates that nearly one in 10 distressed Americans (9.5 percent) in 2014 still did not have health insurance that would give them access to a psychiatrist or counselor, a slight rise from 2006, when 9 percent lacked any insurance. About 10.5 percent in 2014 experienced delays in getting professional help due to insufficient mental health coverage, while 9.5 percent said they experienced such delays in 2006. And 9.9 percent could not afford to pay for their psychiatric medications in 2014, up from 8.7 percent in 2006.
"Based on our data, we estimate that millions of Americans have a level of emotional functioning that leads to lower quality of life and life expectancy," says Weissman. "Our study may also help explain why the U.S. suicide rate is up to 43,000 people each year."
She says her group's next research report will detail how underdiagnosis of SPD impacts physician practices and encourages overuse of other health care services.
Senior study investigator and NYU Langone clinical professor Cheryl Pegus, MD, MPH, who also serves as director of general internal medicine and clinical innovation, says physicians, especially in primary care, can play a bigger role in screening people and detecting signs of SPD and potential suicide.
"Utilizing tools at the time of intake on all patients allows us to collect important data and devise strategies for care," says Pegus. "Our study supports health policies designed to incorporate mental health services and screenings into every physician's practice through the use of electronic medical records, and by providing training for all health care professionals, as well as the right resources for patients."
Besides Weissman and Pegus, other NYU Langone researchers involved in this analysis, which took four years to complete and was self-funded by NYU Langone, are Jeannette Beasley, PhD, MPH, RD; Melanie Jay, MD, MS; and Dolores Malaspina, MD, MS, MPH. Additional research support was provided by study co-investigator David Russell, PhD, at the Visiting Nurse Service of New York.