There’s an interesting article by J. Sareen et al on Cambridge Journals Online, September 2013. It’s call Common mental disorder diagnosis and need for treatment are not the same: findings from a population-based survey. Five of the six authors are working at universities in Canada, the sixth at a university in California. [Thanks to Mad in America for the link to the abstract. The full article is, unfortunately, behind a paywall.]
“Controversy exists regarding whether people in the community who meet criteria for a non-psychotic mental disorder diagnosis are necessarily in need of treatment.”
This seems to me to be particularly relevant today, when there is a great call for increased access to mental health services in the wake of mass murders, natural disasters, and other adverse events.
The authors focused on longitudinal outcomes of individuals who met the criteria for depression, anxiety, and substance use (DAS) disorders. Psychotic disorders were specifically excluded.
A nationally representative sample of 34,653 non-institutionalized adults were interviewed at two time points, three years apart. During each interview, the participants were assessed for:
- meeting the criteria for a DAS disorder
- use of mental health services
- quality of life
“Individuals with a DAS disorder who had not previously received any treatment were significantly more likely than those who had been previously treated to have remission of their index disorder(s) without subsequent treatment, to be free of co-morbid disorder(s) and not to have attempted suicide during the 3-year follow-up period”
“Individuals with an untreated DAS disorder at baseline have a substantial likelihood of remission without any subsequent intervention.”
The study in question was not a randomized controlled trial, so it’s possible that the untreated individuals who went on to do better than those who did receive treatment had less serious problems and/or better coping skills to begin with.
On the other hand, the finding is consistent with, and lends a measure of support to, the idea that, in general, mental health treatment has a damaging and disempowering effect which outweighs any putative benefits.
The research also presents a formidable challenge to the frequently-heard call for expansion of mental health services.
At the very least, the research is a warning to psychiatrists, from a respectable and apparently unbiased source, that their cherished assumptions may be false, and that they may be doing more harm than good. The article has been available online since December 2012. Yet I have detected no sense of concern within the psychiatric community with regards to the implications of this research. Nor am I aware of any great push from within psychiatry to conduct further research to clarify these matters.