# The Numbers Count: Mental Disorders in America

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NIH Publication No. 06-4584
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## Mental Disorders in America

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.
In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
Mood Disorders

## Major Depressive Disorder

* Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.
* Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
* While major depressive disorder can develop at any age, the median age at onset is 32.
* Major depressive disorder is more prevalent in women than in men.

## Dysthymic Disorder

* Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year. This figure translates to about 3.3 million American adults.
* The median age of onset of dysthymic disorder is 31.

## Bipolar Disorder

* Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.
* The median age of onset for bipolar disorders is 25 years.

## Suicide

* In 2004, 32,439 (approximately 11 per 100,000) people died by suicide in the U.S.
* More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.
* The highest suicide rates in the U.S. are found in white men over age 85.
* Four times as many men as women die by suicide9; however, women attempt suicide two to three times as often as men.

## Schizophrenia

* Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia.
* Schizophrenia affects men and women with equal frequency.
* Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.

## Anxiety Disorders

Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).
* Approximately 40 million American adults ages 18 and older, or about 18. percent of people in this age group in a given year, have an anxiety disorder.
* Anxiety disorders frequently co-occur with depressive disorders or substance abuse.
* Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5

## Panic Disorder

* Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.
* Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.
* About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.

## Obsessive-Compulsive Disorder (OCD)

* Approximately 2.2 million American adults age 18 and older, or about 1.0 percent of people in this age group in a given year, have OCD.
* The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19.5

## Post-Traumatic Stress Disorder (PTSD)

* Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.
* PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.
* About 30 percent of Vietnam veterans experienced PTSD at some point after the war. The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

## Generalized Anxiety Disorder (GAD)

* Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD in a given year.
* GAD can begin across the life cycle, though the median age of onset is 31 years old.

## Social Phobia

* Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.
* Social phobia begins in childhood or adolescence, typically around 13 years of age.

## Agoraphobia

Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.
* Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.
* The median age of onset of agoraphobia is 20 years of age.

## Specific Phobia

Specific phobia involves marked and persistent fear and avoidance of a specific object or situation.
* Approximately 19.2 million American adults age 18 and over, or about 8.7 percent of people in this age group in a given year, have some type of specific phobia.
* Specific phobia typically begins in childhood; the median age of onset is seven years.

## Eating Disorders

The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
* Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia4 and an estimated 35 percent of those with binge-eating disorder are male.
* In their lifetime, an estimated 0.5 percent to 3.7 percent of females suffer from anorexia, and an estimated 1.1 percent to 4.2 percent suffer from bulimia.
* Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.
* The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

## Attention Deficit Hyperactivity Disorder (ADHD)

* ADHD, one of the most common mental disorders in children and adolescents, also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.
* ADHD usually becomes evident in preschool or early elementary years. The median age of onset of ADHD is seven years, although the disorder can persist into adolescence and occasionally into adulthood.

## Autism

Autism is part of a group of disorders called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms.
* Estimating the prevalence of autism is difficult and controversial due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria. A recent study reported the prevalence of autism in 3-10 year-olds to be about 3.4 cases per 1000 children.
* Autism and other ASDs develop in childhood and generally are diagnosed by age three.
* Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.

## Alzheimer's Disease

* AD affects an estimated 4.5 million Americans. The number of Americans with AD has more than doubled since 1980.
* AD is the most common cause of dementia among people age 65 and older.
* Increasing age is the greatest risk factor for Alzheimer’s. In most people with AD, symptoms first appear after age 65. One in 10 individuals over 65 and nearly half of those over 85 are affected. Rare, inherited forms of Alzheimer’s disease can strike individuals as early as their 30s and 40s.
* From the time of diagnosis, people with AD survive about half as long as those of similar age without dementia.

## For More Information

Mental Health Information and Organizations from NLM's MedlinePlus (en Español).

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Kessler RC, Chiu WT, Demler O, Walters EE. "Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)". Archives of General Psychiatry, 2005 Jun;62(6):617-27.
* 1 2 U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/
* 1 2 The World Health Organization. The World Health Report 2004: Changing History, Annex Table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002. Geneva: WHO, 2004.
* ↑ American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.
* 1 2 3 4 5 6 7 8 9 10 11 Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)." Archives of General Psychiatry. 2005 Jun;62(6):593-602.
* ↑ Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. "The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R)." Journal of the American Medical Association, 2003; Jun 18;289(23):3095-105.
* ↑ Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (producer). Web-based Injury Statistics Query and Reporting System (WISQARS). Available online from: URL: http://www.cdc.gov/ncipc/wisqars/default.htm accessed December 2006.
* ↑ Conwell Y, Brent D. "Suicide and aging I: patterns of psychiatric diagnosis." International Psychogeriatrics, 1995; 7(2): 149-64.
* ↑ Kochanek KD, Murphy SL, Anderson RN, Scott C. "Deaths: final data for 2002." National Vital Statistics Reports. 2004 Oct 12;53 (5):1-115.
* ↑ Weissman MM, Bland RC, Canino GJ, et al. "Prevalence of suicide ideation and suicide attempts in nine countries." Psychological Medicine, 1999; 29(1): 9-17.
* ↑ Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. "The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services." Archives of General Psychiatry. 1993 Feb;50(2):85-94.
* 1 2 3 Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
* ↑ Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS. "Contractual report of findings from the National Vietnam veterans readjustment study." Research Triangle Park, NC: Research Triangle Institute, 1988.
* ↑ Andersen AE. "Eating disorders in males." In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995;177-87.
* 1 2 Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. "Binge eating disorder: its further validation in a multisite study." International Journal of Eating Disorders. 1993 Mar;13(2):137-53.
* ↑ American Psychiatric Association Work Group on Eating Disorders. "Practice guideline for the treatment of patients with eating disorders (revision)." American Journal of Psychiatry. 2000 Jan;157(1 Suppl):1-39.
* ↑ Bruce B, Agras WS. "Binge eating in females: a population-based investigation." International Journal of Eating Disorders. 1992;12:365-73.
* ↑ Sullivan PF. "Mortality in anorexia nervosa." American Journal of Psychiatry. 1995 Jul;152(7):1073-4.
* 1 2 Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. "Prevalence of Autism in a US Metropolitan Area." The Journal of the American Medical Association. 2003 Jan 1;289(1):49-55.
* 1 2 Fombonne E. "Epidemiology of autism and related conditions." In: Volkmar FR, ed. Autism and pervasive developmental disorders. Cambridge, England: Cambridge University Press, 1998; 32-63.
* ↑ Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. "Alzheimer disease in the US population: prevalence estimates using the 2000 census." Archives of Neurology. 2003 Aug;60(8):1119-22.
* ↑ National Institute on Aging, Progress Report on Alzheimer’s disease 2004-2005. NIH Publication No. 05-5724. Bethesda, MD: National Institute on Aging, 2005. Available from http://www.alzheimers.org/pr04-05/index.asp
* ↑ Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO. "Prevalence of Alzheimer's disease in a community population of older persons: Higher than previously reported." The Journal of the American Medical Association. 1989 Nov 10;262(18):2551-6.
* ↑ Bird TD, Sumi SM, Nemens EJ, Nochlin D, Schellenberg G, Lampe TH, Sadovnick A, Chui H, Miner GW, Tinklenberg J. "Phenotypic heterogeneity in familial Alzheimer's disease: a study of 24 kindreds." Annals of Neurology. 1989 Jan;25(1):12-25.
* ↑ Larson EB, Shadlen MF, Wang L, McCormick WC, Bowen JD, Teri L, Kukull WA. "Survival after initial diagnosis of Alzheimer disease." Annals of Internal Medicine. 2004 Apr 6;140(7):501-9.