Edited by : Neeraja Sankaran
R.C. Kessler, K.A. McGonagle, S.Y. Zhao, C.B. Nelson, M. Hughes, S. Eshleman, H.U. Wittchen, K.S. Kendler, "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States-Results from the National Comorbidity Survey," Archives of General Psychiatry, 51:8-19, 1994. (Cited in more than 100 publications through December 1995) Edited by : Neeraja Sankaran
Comments by Ronald Kessler, University of Michigan, Ann Arbor
This publication is the first in a series of 30 reports to emerge from the National Comorbidity Survey (NCS), a nationwide collaborative epidemiological study of the prevalence, causes, and consequences of psychiatric disorders in the United States. The work is supported by the U.S. Alcohol, Drug Abuse, and Mental Health Administration in Rockville, Md.
"The survey consisted of data on over 8,000 people between the ages of 15 and 54 throughout the [U.S.], using lay interview methods developed in an earlier study [L.M. Robins et al., Arch. Gen. Psych., 38:381-89, 1981] sponsored by the National Institute of Mental Health in the 1980s," reports Ronald Kessler, a professor of sociology at the University of Michigan and program director of the Survey Research Center at the Institute of Social Research there.
"In this first paper, we reported four types of results," says Kessler. "First, we reported estimates of how many people had suffered from psychiatric disorders in their lifetime, which was nearly half the population. Next, we reported parallel estimates for people who had psychiatric illnesses in the past year, which was over one-quarter of the population. Third, we showed that a vast majority-nearly 90 percent of the severe disorders [reported in the past year]-occurred to people who have a lifetime history of three or more disorders, demonstrating that while the distribution of psychiatric illness is widespread, the majority are associated with high comorbidity. Finally, we examined professional help-seeking [by patients] and found that only one-fifth of the people with a disorder in the past year had sought or received any type of professional help.
REMOVING BARRIERS: Mental health studies such as the one conducted by Michigan's Ronald Kessler and colleagues are used to assess how many people in high-risk groups seek professional help.
"The reason why this report has been so highly cited is that it provides the first nationally representative data on this important class of disorders," he suggests. "The results are striking because the numbers of people who have suffered from some sort of psychiatric disorder are so large." Future studies aim to elucidate possible explanations for these figures.
The most common single disorders were depression, social and simple phobias, and alcohol dependence. Kessler remarks that the results were especially notable because cases involving severe, persistent disorders were mostly related to the co-occurrence of several disorders, rather than the occurrence of any one type of disorder. "This result," he says, "highlights the importance of preventing the onset of secondary co-morbid diseases, a topic that has so far been neglected in psychiatric epidemiology."
The report has very important social implications, according to Kessler. For example, he remarks, "having national data like this provides the context for formulating better policies with respect to the distribution of resources for prevention and treatment."
To this end, "ongoing work with NCS data is looking for ways to target high-risk groups for special outreach efforts aimed at prevention and to effectively remove barriers to seeking professional help."
Neeraja Sankaran is a science writer based in the Los Angeles area.