6 ms·

Enduring Mental Health: Prevalence and Prediction

58 points by aw1621107 6y ago

aw1621107 6y ago
Abstract: > We review epidemiological evidence indicating that most people will develop a diagnosable mental disorder, suggesting that only a minority experience enduring mental health. This minority has received little empirical study, leaving the prevalence and predictors of enduring mental health unknown. We turn to the population-representative Dunedin cohort, followed from birth to midlife, to compare people never-diagnosed with mental disorder (N = 171; 17% prevalence) to those diagnosed at 1–2 study waves, the cohort mode (N = 409). Surprisingly, compared to this modal group, never-diagnosed Study members were not born into unusually well-to-do families, nor did their enduring mental health follow markedly sound physical health, or unusually high intelligence. Instead, they tended to have an advantageous temperament/personality style, and negligible family history of mental disorder. As adults, they report superior educational and occupational attainment, greater life satisfaction, and higher-quality relationships. Our findings draw attention to “enduring mental health” as a revealing psychological phenotype and suggest it deserves further study.
- epicureanideal 6y ago
  > Instead, they tended to have an advantageous temperament/personality style, and negligible family history of mental disorder. As adults, they report superior educational and occupational attainment, greater life satisfaction, and higher-quality relationships. ———- I assume they adjusted for this, but this is funny at a surface level reading. People with superior educational attainment, greater life satisfaction, and higher quality relationships have fewer mental health issues. Who would’ve thought?! Another take: we have medicalized the normal human range of human emotions to the point that 83% of the population will at some point be considered to have a mental disorder.
  - usgroup 6y ago
    I think that they argue that the causality works the other way around. All men are mortal doesn’t mean all mortals are men.
usgroup 6y ago
It feels anecdotally correct. Consider things like depression as a result of bereavement or child birth (for women). Insomnia , anxiety , etc. So many ways to be “mentally ill” temporarily. That said it does seem that the extreme prevalence of something over a long period of time makes dubious the claim that it is a “mental illness”. It feels like treating people as defective for falling over because they don’t have 3 legs ...
- __s 6y ago
  It might not even be indication of over diagnosis. Everyone gets physically ill sometimes
  - usgroup 6y ago
    that's a good point if the two are comparable.
roenxi 6y ago
The entire field o mental health revolves around the idea that there is some sort of 'this is how brains are meant to work'. In extreme cases that works well (eg, lead poisoning), in edge cases there is a lot of grey. One uncomfortable part of mild depression is the questions around how correct it is. It is easy to logically deduce depression as a rational response to the world.
- raziel2p 6y ago
  I don't know about that. I think you could also logically deduce euphoria as a response to the world. It depends on what you want to do with your life (both long-term and short-term) and how the world can accomodate that.
- vharuck 6y ago
  The field of mental health says something is a disorder if it causes a noticeable and real problem. It's a beautifully simple idea: "Is it causing a problem? If yes, let's help. If no, leave well enough alone." Quoting Wikipedia's summary (can't find my DSM-IV): >According to DSM-IV, a mental disorder is a psychological syndrome or pattern which is associated with distress (e.g. via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however it excludes normal responses such as grief from loss of a loved one, and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual. https://en.wikipedia.org/wiki/Mental_disorder https://en.wikipedia.org/wiki/Mental_disorder We can argue about where to draw the line for distress or disability, but I just wanted to counter the myth that shrinks are totally subjective.
rjkennedy98 6y ago
Wow could there be better evidence of medicalizing “normal” than this article
raziel2p 6y ago
I know that in my close group of friends more than half have opened up about dealing with depression but that it might be that way for the general population is counter-intuitive to me. It makes sense when you think about it, though: Obviously the couple walking down the street are going to seem happy, and all the acquaintances you see once a month won't be the ones opening up to you.
ojnabieoot 6y ago
Comments here are predictably (and depressingly) misstating this research as "medicalizing normal emotions." This is due to two widespread misconceptions: 1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature) 2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems. If someone is deeply depressed after their mother dies, they should be considered as having a mental injury that should heal on its own but needs to be monitored for "infection" or otherwise problematic healing. Saying ahead of time "this person isn't mentally ill so this is just normal bereavement" is bad medicine and bad science. US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." If you were to try to draw a similarly strong distinction between "people with stomach problems" and "people without stomach problems" the absurdity would be self-evident: there is no reason to lump people with norovirus in with people with IBD. But because mental illness is so much more mysterious (and, frankly, scary), and so entwined with social and societal expectations and norms, it is much harder to approach it from the same medical-first perspective.
- montagg 6y ago
  The book Emotional First Aid by Dr. Guy Winch was my first introduction to a mental model of emotions that allowed for this type of thinking: injuries, ways to heal, and the difference between an emotional paper cut and an emotional broken arm and how it’s common to treat the latter like the former. Great book for anyone who wants to learn strategies for taking their own emotions and needs seriously.
- Godel_unicode 6y ago
  I've always been surprised by the lack of the chronic vs acute verbiage that is used other places in medicine, for instance in physical pain management.
- DubiousPusher 6y ago
  > (along with the idea that all mental illnesses are neurostructural in nature) I agree with everything you said except I'm having trouble with this bit. Neurostructural as opposed to what? All thoughts are physical things happening in the head. The brain changes. Sometimes it changes to a state that creates problems for a person (perhaps long term depression spurred by grieving a loved one.) Sometimes talk or time can change it back. Or change it to another state that isn't impaired by ticks or grief or anger. But it is a physical process. I understand that sometimes working at the granular level of neurons or chemistry isn't as productive as working at the psychological level. i.e. sometimes talking about emotions can get the brain to start to encourage different pathways that will eventually become the norm and take one away from the problematic ones. But this is still a neurostructural change in the brain. It is just mediated by the brain itself. Perhaps I am missing some subtle point or misinterpreting you?
klft 6y ago
Summary: Study was done with a largely Caucasian, New Zealand cohort born in the 1970s. Factors which correlate with enduring mental health: Childhood factors: - little evidence of strong negative emotions - social support and sociability - self-control Familiy environment factors: - fewer first- and second-degree relatives with mental health issues - less negative discipline - reduced likelihood of parental loss Not relevant: - socioeconomic advantage - perinatal complications - physical health - intelligence

58 points by aw1621107 6y ago

Abstract: > We review epidemiological evidence indicating that most people will develop a diagnosable mental disorder, suggesting that only a minority experience enduring mental health. This minority has received little empirical study, leaving the prevalence and predictors of enduring mental health unknown. We turn to the population-representative Dunedin cohort, followed from birth to midlife, to compare people never-diagnosed with mental disorder (N = 171; 17% prevalence) to those diagnosed at 1–2 study waves, the cohort mode (N = 409). Surprisingly, compared to this modal group, never-diagnosed Study members were not born into unusually well-to-do families, nor did their enduring mental health follow markedly sound physical health, or unusually high intelligence. Instead, they tended to have an advantageous temperament/personality style, and negligible family history of mental disorder. As adults, they report superior educational and occupational attainment, greater life satisfaction, and higher-quality relationships. Our findings draw attention to “enduring mental health” as a revealing psychological phenotype and suggest it deserves further study.

epicureanideal 6y ago
> Instead, they tended to have an advantageous temperament/personality style, and negligible family history of mental disorder. As adults, they report superior educational and occupational attainment, greater life satisfaction, and higher-quality relationships. ———- I assume they adjusted for this, but this is funny at a surface level reading. People with superior educational attainment, greater life satisfaction, and higher quality relationships have fewer mental health issues. Who would’ve thought?! Another take: we have medicalized the normal human range of human emotions to the point that 83% of the population will at some point be considered to have a mental disorder.
- usgroup 6y ago
  I think that they argue that the causality works the other way around. All men are mortal doesn’t mean all mortals are men.

usgroup 6y ago

It feels anecdotally correct. Consider things like depression as a result of bereavement or child birth (for women). Insomnia , anxiety , etc. So many ways to be “mentally ill” temporarily. That said it does seem that the extreme prevalence of something over a long period of time makes dubious the claim that it is a “mental illness”. It feels like treating people as defective for falling over because they don’t have 3 legs ...

__s 6y ago
It might not even be indication of over diagnosis. Everyone gets physically ill sometimes
- usgroup 6y ago
  that's a good point if the two are comparable.

roenxi 6y ago

The entire field o mental health revolves around the idea that there is some sort of 'this is how brains are meant to work'. In extreme cases that works well (eg, lead poisoning), in edge cases there is a lot of grey. One uncomfortable part of mild depression is the questions around how correct it is. It is easy to logically deduce depression as a rational response to the world.

raziel2p 6y ago
I don't know about that. I think you could also logically deduce euphoria as a response to the world. It depends on what you want to do with your life (both long-term and short-term) and how the world can accomodate that.
vharuck 6y ago
The field of mental health says something is a disorder if it causes a noticeable and real problem. It's a beautifully simple idea: "Is it causing a problem? If yes, let's help. If no, leave well enough alone." Quoting Wikipedia's summary (can't find my DSM-IV): >According to DSM-IV, a mental disorder is a psychological syndrome or pattern which is associated with distress (e.g. via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however it excludes normal responses such as grief from loss of a loved one, and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual. https://en.wikipedia.org/wiki/Mental_disorder https://en.wikipedia.org/wiki/Mental_disorder We can argue about where to draw the line for distress or disability, but I just wanted to counter the myth that shrinks are totally subjective.

rjkennedy98 6y ago

Wow could there be better evidence of medicalizing “normal” than this article

raziel2p 6y ago

I know that in my close group of friends more than half have opened up about dealing with depression but that it might be that way for the general population is counter-intuitive to me. It makes sense when you think about it, though: Obviously the couple walking down the street are going to seem happy, and all the acquaintances you see once a month won't be the ones opening up to you.

ojnabieoot 6y ago

Comments here are predictably (and depressingly) misstating this research as "medicalizing normal emotions." This is due to two widespread misconceptions: 1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature) 2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems. If someone is deeply depressed after their mother dies, they should be considered as having a mental injury that should heal on its own but needs to be monitored for "infection" or otherwise problematic healing. Saying ahead of time "this person isn't mentally ill so this is just normal bereavement" is bad medicine and bad science. US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." If you were to try to draw a similarly strong distinction between "people with stomach problems" and "people without stomach problems" the absurdity would be self-evident: there is no reason to lump people with norovirus in with people with IBD. But because mental illness is so much more mysterious (and, frankly, scary), and so entwined with social and societal expectations and norms, it is much harder to approach it from the same medical-first perspective.

montagg 6y ago
The book Emotional First Aid by Dr. Guy Winch was my first introduction to a mental model of emotions that allowed for this type of thinking: injuries, ways to heal, and the difference between an emotional paper cut and an emotional broken arm and how it’s common to treat the latter like the former. Great book for anyone who wants to learn strategies for taking their own emotions and needs seriously.
Godel_unicode 6y ago
I've always been surprised by the lack of the chronic vs acute verbiage that is used other places in medicine, for instance in physical pain management.
DubiousPusher 6y ago
> (along with the idea that all mental illnesses are neurostructural in nature) I agree with everything you said except I'm having trouble with this bit. Neurostructural as opposed to what? All thoughts are physical things happening in the head. The brain changes. Sometimes it changes to a state that creates problems for a person (perhaps long term depression spurred by grieving a loved one.) Sometimes talk or time can change it back. Or change it to another state that isn't impaired by ticks or grief or anger. But it is a physical process. I understand that sometimes working at the granular level of neurons or chemistry isn't as productive as working at the psychological level. i.e. sometimes talking about emotions can get the brain to start to encourage different pathways that will eventually become the norm and take one away from the problematic ones. But this is still a neurostructural change in the brain. It is just mediated by the brain itself. Perhaps I am missing some subtle point or misinterpreting you?

klft 6y ago

Summary: Study was done with a largely Caucasian, New Zealand cohort born in the 1970s. Factors which correlate with enduring mental health: Childhood factors: - little evidence of strong negative emotions - social support and sociability - self-control Familiy environment factors: - fewer first- and second-degree relatives with mental health issues - less negative discipline - reduced likelihood of parental loss Not relevant: - socioeconomic advantage - perinatal complications - physical health - intelligence