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Prevalence of Mental Illness Might Be Underreported

January 15, 2014

People who were asked to report their past physical and mental health disorders tended to consistently under-report their previous mental disorders, prompting researchers to conclude that the prevalence of mental disorders may be substantially higher than previously thought. 

Researchers published their findings in the January 8 online JAMA Psychiatry. 

“The takeaway is that lifetime estimates based on [participant] recall in cross-sectional surveys underestimate the occurrences of mental disorders over the lifetime,” said senior author Ramin Mojtabai, MD, PhD, MPH, MA, associate professor at the Johns Hopkins Bloomberg School of Public Health, Baltimore. 

Dr. Mojtabai and colleagues came to their findings after questioning 1,071 adults who had participated in the Baltimore Epidemiologic Catchment Area Survey since the early 1980s. The longitudinal study included four sets of interviews spread out over more than 2 decades and included questions that yielded psychiatric diagnoses based on DSM-III and DSM-IIIR criteria. 

During the most recent round of interviews, which took place in 2004 and 2005, participants were asked to provide retrospective evaluations in six categories of mental health disorders and six categories of physical disorders. 

When researchers compared self-reports to the cumulative data from earlier interviews, they found the following discrepancies between the percentage of patients who reported a particular mental health disorder compared to the percentage that had previously received the diagnosis: 

  • Major depressive disorder: 4.5% vs 13.1%
  • Obsessive-compulsive disorder: 0.6% vs 7.1%
  • Panic disorder: 2.5% vs 6.7%
  • Social phobia: 12.6% vs 25.3%
  • Alcohol abuse or dependence: 9.1% vs 25.9%
  • Drug abuse or dependence: 6.7% vs 17.6% 

In comparison, participants tended to report past physical disorders with much more accuracy, researchers said. For example, just one out of 10 underreported diabetes. 

“Stigma associated with mental disorders, as well as the fluctuating course of mental illnesses, might partly explain the discrepancies, as well as differences in ages of onset of mental and physical disorders,” said Dr. Mojtabai. 

“Mental disorders start earlier and have a higher prevalence in early to mid-life, whereas physical disorders are typically illnesses of middle and older age and tend to be chronic.” 

—Jolynn Tumolo 


1. Takayanagi Y, Spira AP, Roth KB, Gallo JJ, Eaton WW, Mojtabai R. Accuracy of reports of lifetime mental and physical disorders: results from the Baltimore Epidemiological Catchment Area Study. JAMA Psychiatry. 2014 Jan. 8. [Epub ahead of print]. 

2. Mental disorders in mid-life and older adulthood may be substantially more prevalent than previously reported [press release]. Charlottesville, VA: Newswise; Jan. 8, 2014.

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