Statistics 1: How common is mental distress?

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Understanding mental health statistics
Prevalence of mental health problems in Great Britain
How many people in Britain experience mental health problems?
What is the most common form of mental distress?
What is the least common form of mental distress?
Prevalence of mental health problems - by gender
Evidence from several studies
Anxiety
Depression
Eating problems
Postnatal depression
Dementia
Phobias
Personality disorders
Bipolar disorder (manic depression)
Obsessive compulsive disorder
Schizophrenia
Symptoms of mental distress
What is the most common symptom of mental distress?
Prevalence of neurotic symptoms – by gender
Characteristics of adults with psychiatric disorders
By marital status
By employment status
By social class
By family unit type
By housing type
By locality
By ethnicity
Appendix 1: Notes on the classification system used by ONS

Note on terminology: the language and terminology of psychiatric diagnosis used in this document refers to the original sources used. The use of such language in no way implies Mind’s unqualified acceptance of it. It has been retained for the sake of accuracy.

Understanding mental health statistics

The frequency of mental health problems is well documented statistically. However, these figures need to be treated with some caution. Often widely differing figures will be given for the same mental health problem, making it difficult to determine exactly how common it is. This is partly because these figures are not always measuring the same thing. For example, in order to reflect the fact that mental health is not fixed but likely to change over time, a variety of different figures are used. The most common are:

Prevalence: this measures the number of people with a particular diagnosis at a given time.

Lifetime prevalence: this measures the number of people who have experienced a particular mental health problem at any time in their lives.

Incidence: this measures the number of new cases of a particular mental health problem that appear in a given time period.

Often these figures are compared to provide further information about a mental health problem. For example, comparing the number of new cases, (the incidence) with the number who are ill at any one time (the prevalence) can give us a rough idea of the average amount of time a mental health problem is likely to last.

Another important factor is the kind of sample used to arrive at a particular figure. Often the number of people treated by health professionals is used to determine how common a mental health problem is. However, this is likely to ignore all those who have not come into contact with services. Furthermore, psychiatric diagnosis is often far from straightforward – a person’s diagnosis may be changed several times in the course of their treatment. An alternative is to take a sample of the whole population and interview people, according to a standard set of criteria, to see if they have a mental health problem. This approach, known as a community survey, although expensive and time consuming, is usually the most reliable.

For the purposes of this factsheet most figures are taken from the latest Office for National Statistics (ONS) survey carried out in 2000, the largest community survey carried out in Great Britain. This is the second such survey done. The first was carried out in 1993, with most figures published in 1995. The surveys give figures for prevalence, estimating the number of people with a particular diagnosis at the time of the studies. The figures for 1993 have been reanalysed by the ONS in order to allow comparison between 1993 and 2000, as some changes were made in the 2000 survey.

The 2000 survey also gives figures that show characteristics of adults with psychiatric disorders compared with adults not diagnosed with any such disorders. These figures can sometimes give more useful information than other figures. For example, the study shows that 50 per cent of males with a psychiatric problem own their home with a mortgage. This may sound like a few to some and like a high figure to others. The fact is that the figure is the same for males with no psychiatric disorders – 50 per cent. However, if we look at figures for employment, we find that 61 per cent of male adults with a psychiatric disorder are in full-time or part-time employment. The figure for men with no psychiatric disorder is 14 per cent higher – 75 per cent. When comparing the two figures, they give us more information than when viewed on their own.

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Prevalence of mental health problems in Great Britain

How many people in Britain experience mental health problems?
Estimates of the prevalence of mental distress in Britain vary. The Office for National Statistics or ONS (previously the Office for Population and Census surveys or OPCS) puts the figure at one in six adults at any one time. [1] Another major survey that is frequently quoted puts the figure at one in four. [2] The one in six figure given by the ONS represents those people defined as having ‘significant’ mental health problems, whilst the latter survey uses a wider definition of mental health problems. The breakdown below gives an overview of what treatment those who experience mental health problems are likely to seek and get:

• around 300 people out of 1,000 will experience mental health problems every year in Britain
• 230 of these will visit a GP
• 102 of these will be diagnosed as having a mental health problem
• 24 of these will be referred to a specialist psychiatric service
• 6 will become inpatients in psychiatric hospitals.

(Source: based on figures from Goldberg, D. & Huxley, P, 1992, Common mental disorders ­ a bio-social model, Routledge.)

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What is the most common form of mental distress?

Mixed anxiety and depression, according to the ONS 2000 survey, is experienced by 9.2 per cent of adults in Britain. This is followed by general anxiety at 4.7 per cent and depression (without the symptoms of anxiety) at 2.8 per cent. As indicated in the table below, the figures show an increase (from 1993 to 2000) in the prevalence of mixed anxiety with depression of 1.4 per cent (from 7.8 per cent to 9.2 per cent).

What is the least common form of mental distress?

The least common disorder in the ONS survey is panic disorder, affecting 0.7 per cent of the population of Britain. In 2000 there was a slight decrease, 0.5 per cent, in the prevalence of obsessive compulsive disorder compared with the figures for 1993.

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Prevalence of mental health problems - by gender (people aged between 16 to 64 years)

All figures are percentages

Source: ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain.

Note: People may have more than one type of neurotic disorder, so the percentage with any disorder is not the sum of those with specific disorders.

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Evidence from several studies on different mental health problems

Anxiety
The Office for National Statistics estimates that 4.7 per cent of adults experience generalised anxiety disorders not including depression, at any one time. [3] This is in line with other studies showing a prevalence of between 2 per cent and 5 per cent of the population. [4] The study shows that a further 9.2 per cent have mixed anxiety and depression and that anxiety is far more common in women than in men. The prevalence of mixed anxiety and depression is 11.2 per cent in women as compared to 7.2 per cent in men.

Panic disorders are related to anxiety. According to the ONS study 7 people per 1,000 develop a panic disorder and this appears to be the same across all age groups and roughly the same for men and women, with a female to male ratio of 7:8. [5]

Depression
Depression with anxiety is experienced by 9.2 per cent of people in Britain, and depression without anxiety by 2.8 per cent. [6] Overall, depression occurs in 1 in 10 adults or 10 per cent of the population in Britain at any one time, according to the ONS, matching closely figures from other studies. [7] [8] Estimates of lifetime prevalence vary from 1 in 6 to 1 in 4. [9] A summary of studies on more severe depression gives a figure of 1 in 20 people at any one time who suffer major or ‘clinical’ depression. [10]

If these statistics are further broken down it can be seen that women have a higher prevalence of mixed anxiety and depressive disorder than men. The ONS figure for women is 11.2 per cent of the population and for men 7.2 per cent. [11] The figures for 2000, for both women and men, show an increase compared with figures from 1993. Other studies have repeatedly shown a similar, but somewhat higher ratio of roughly 2:1 for women compared to men. [12] However, recent studies suggest depression occurs as often in men though women are twice as likely to be diagnosed and treated. It is argued that men tend to express their symptoms differently, for example, through the use of alcohol and drugs, and are unwilling to admit to the symptoms of depression. [13] It is therefore interesting to note that the figures for men are rising faster than the figures for women. This may indicate that men now are more likely to admit to feeling depressed.

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Eating problems

NICE (The National Institute for Health and Clinical Excellence) reports that the incidence of anorexia nervosa is around 19 per 100,000 of the population per year for women and 2 per 100,000 per year for men. [14] NICE also suggests that the prevalence for bulimia nervosa is between 0.5 and 1.0 per cent for young women. Around 90 per cent of those diagnosed with bulimia are thought to be girls, according to NICE.

Beating Eating Disorder (beat) suggests that the prevalence rates for anorexia might be around 1–2 per cent. [15] For bulimia they suggest a prevalence rate of 1-3 per cent.

As many cases of eating disorder are unreported or undiagnosed, the actual figures are likely to be much higher. beat suggests that as many as 1.5 million people in the UK might be experiencing some form of eating disorder. [16]

Postnatal depression

The most common form of postnatal disturbance is the ‘baby blues’ which is said to be experienced by at least half of all mothers in the western world. However, different studies suggest different figures for the number of women affected by ‘baby blues’, and estimates vary between 15 and 85 per cent. [17] Baby blues usually lasts for a few hours or a few days. [18] The condition is so common that it is considered as normal.

Some women have a much more severe change in mood after the birth of their child and may be assessed as experiencing postnatal depression (PND). The condition is often assessed by a health visitor using the Edinburgh Postnatal Depression Scale. A number of studies indicate that 10-15 per cent of new mothers will experience PND. [19]

Puerperal psychosis is a severe and relatively rare form of postnatal depression affecting between 0.1 and 0.2 per cent of all new mothers. [20]

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Dementia
5 per cent of people in the UK over the age of 65, and 20 per cent of people over the age of 80 are affected by dementia. [21] There are some 650,000 people with dementia known to health authorities in the UK. Over two thirds of them are diagnosed with Alzheimer’s disease. [22] The Alzheimer’s Society reports that dementia currently affects around 700,000 individuals in the UK. By 2010, the number is expected to rise to around 870,000. [23] By 2021, the number is expected to increase to around 1 million. The number may be closer to 2 million by 2051. [24] This is mainly due to an increase in the UK's ageing population. However, conditions such as high cholesterol and high blood pressure can increase risk of dementia. As these conditions are on the increase, they are also thought to contribute to an increase in the number of people suffering from dementia. [25]

Phobias
The Office for National Statistics found that 1.9 per cent of adults in Britain experience phobias. [26] In this study, it is shown that women are twice as likely as men to experience phobias. Other studies show widely differing rates: one author quotes two community surveys - one in Canada, giving a prevalence rate of 7.7 per cent; and another very large US survey, giving a rate of 13.3 per cent. [27]

Personality disorders
In Britain the prevalence of personality disorder ranges from 2 per cent to 13 per cent according to different studies. The concept of a personality disorder is controversial and use of this diagnosis is often questioned. Some diagnoses are applied more commonly to men (such as dissocial personality disorder), while others are applied more commonly to women (such as borderline personality disorder). [28]
ONS reports that the prevalence rate for personality disorder in the UK is around 5.4 per cent for men and 3.4 for women. [29]

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Bipolar disorder (manic depression)
Most studies give a lifetime prevalence of between 1 and 2 per cent for bipolar disorder. [30] The disorder has equal prevalence rates for men and women. [31] Although people who have a first episode of bipolar are likely to experience recurrent episodes, it is estimated that 20 per cent of people who have a first episode of the disorder do not get another. [32]

Obsessive compulsive disorder
Around 1.2 per cent of the population of Britain have obsessive compulsive disorder (OCD) at any one time, according to the ONS survey. [33] Other studies suggest that up to 3 per cent of the population will experience OCD at some time in their lives. [34] Several studies suggest a lifetime prevalence of 2 to 3 per cent. However, NICE suggests that these figures are too high and that some studies may have over-diagnosed people participating in the studies. [35] It appears that studies are divided over whether this is more common for women: the ONS survey gives a female to male ratio of 15:9, whereas other studies have suggested no clear gender difference in diagnostic rates for OCD.

Schizophrenia
Most studies show a lifetime prevalence for schizophrenia of just under 1 per cent. ONS suggests a per year prevalence rate of around 5 per 1000 of the population (0.5 per cent). [36] Based on this figure another study suggest a prevalence at any one time of about 2 per 1000 (0.2 per cent). [37] While prevalence rates are the same for men and women, age and gender together is an important factor: one study shows the incidence for men aged 15-24 is twice that for women, whereas for those between 24-35, it is higher among women. This reflects a common late onset of the illness for women. [38] One estimate suggests that around 37-40 per cent of people diagnosed with psychosis will fit the diagnostic criteria for schizophrenia. [39]

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Symptoms of mental distress

What is the most common symptom of mental distress?

Sleep problems and fatigue are the problems most often reported. In 2000, 29 per cent of all adults reported some sleep problems - an increase of 4 per cent since 1993. More women than men have sleep problems. As indicated in the table below, 34 per cent of women have sleep problems. Among men the figure is 10 per cent lower. Women are also more likely to report fatigue. However, the figures from 2000 show little or no increase from 1993.

Prevalence of neurotic symptoms - by gender (people aged between 16 to 64 years)

All figures are percentages

Source: ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain.

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Characteristics of adults with psychiatric disorders

The following tables show characteristics of adults with psychiatric disorders compared with people who do not have any such disorders. It is important to note that there may be many reasons for the differences between individuals with psychiatric disorders and those with no such disorders. The disorders considered are based on ICD-10 categories of diagnosis (International Classification of Diseases, published by World Health Organisation, 1992). Please note that the following tables do not show the number of people who have been diagnosed with a disorder. Rather, the tables focus on those who have been diagnosed with a disorder with the aim to find out how their life situation is compared to those who have not been diagnosed with a disorder.

Note: all figures in this section are taken from ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain.

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Compared with no disorder, those with a psychiatric disorder are more likely to be separated or divorced (14 per cent compared to 7 per cent). They are less likely to be married or cohabiting (62 per cent compared to 67 per cent).

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This table shows that compared with no disorder, those with a psychiatric disorder are more likely to be economically inactive (39 per cent compared to 28 per cent). They are less likely to be employed (58 per cent compared to 69 per cent). However, it is important to note that the majority of people with psychiatric disorders are employed.

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When compared by social class, there are few differences between those with no disorder and those with a psychiatric disorder. Significant differences can be seen between men and women – but this is not related to their mental health status.

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Compared with no disorder, those with a psychiatric disorder are more likely to be a lone parent (nine per cent compared to four per cent). They are less likely to live with one or both of their parents (nine per cent compared to 14).

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This table shows that compared with no disorder, those with a psychiatric disorder are more likely to rent their home from a local authority or housing association (26 per cent compared to 15 per cent). They are less likely to own their home outright (15 per cent compared to 25).

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Compared with no disorder, those with a psychiatric disorder are more likely to live in an urban area (71 per cent compared to 65 per cent). They are less likely to live in a rural area (21 per cent compared to 26).

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When compared by social class, there are no significant differences between those with no disorder and those with a psychiatric disorder.

Note: Observed differences among the sample according to ethnic group were small, and, because only 4 per cent of the sample in this survey identified themselves as belonging to an ethnic group other than white, any apparent differences in the prevalence of symptoms are difficult to interpret and are unlikely to be statistically significant.

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Appendix 1: notes on the classification system used by the Office for National Statistics

Neurotic disorders, or depression and anxiety disorders, are characterised by a variety of symptoms such as fatigue and sleep problems, forgetfulness and concentration difficulties, irritability, worry, panic, hopelessness and obsessions and compulsions, which are present to such a degree that they cause problems with daily activities and distress.

Psychoses and functional psychoses are disorders that produce disturbances in thinking and perception that are severe enough to distort the person’s perception of the world and the relationship of events in it. Psychoses are normally divided into two groups: organic psychoses, such as dementia and Alzheimer's disease, and functional psychoses which mainly cover schizophrenia and manic depression (although ‘functional psychosis’ does not necessarily have to belong to any one of these two diagnoses and can exist as a diagnosis in itself).

Personality disorder is defined as an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset of adolescence or early adulthood, is stable over time, and leads to distress or impairment.

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References

[1] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[2] Goldberg, D. & Huxley, P. 1992, Common mental disorders ­ a bio-social model, Routledge.
[3] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[4] Hale, A. 1997, ‘ABC of mental health: anxiety’, British medical journal, 314, 28 June, pp.1886-1889.
[5] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[6] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[7] Healy, D. 1998, ‘Gloomy days and sunshine pills’ Openmind, 90, March/April.
[8] Hale, A. 1997, ‘ABC of mental health: depression’ British medical journal, 315, 5 July pp. 43-46.
[9] Bird, L. 1999, The fundamental facts. Mental Health Foundation.
[10] Hale, A. 1997, ‘ABC of mental health: depression’ British medical journal, 315, 5 July pp. 43-46.
[11] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[12] Hammen, C. 1997, Depression, Psychology Press, Hove.
[13] Stewart, G. 2005, Men’s mental health factsheet, Mind.
[14] NICE, 2004, Eating Disorders, Cor interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders, National Clinical Practice Guideline Number CG9, developed by, National Collaboration Centre for Mental Health, commissioned by NICE, The British Psychological Society and Gaskell
[15] beat, 2007, Understanding eating disorders and how you can help, Some Statistics, downloaded 27 Feb 2008, from http://www.b-eat.co.uk/NewsEventsPressMedia/PressMediaInformation/Somestatistics
[16] beat, 2007, Understanding eating disorders and how you can help, Some Statistics, downloaded 27 Feb 2008, from http://www.b-eat.co.uk/NewsEventsPressMedia/PressMediaInformation/Somestatistics
[17] BMJ Best Treatments. 2008, Postnatal depression, The baby blues, BMJ Publishing Group Ltd, downloaded 27 Feb 2008, from http://besttreatments.bmj.com/btuk/conditions/1000691238.html
[18] BMJ Best Treatments. 2008, Postnatal depression, The baby blues, BMJ Publishing Group Ltd, downloaded 27 Feb 2008, from http://besttreatments.bmj.com/btuk/conditions/1000691238.html
[19] Lee, D, Yip, A, Leung, T and Chung, T, 2004, Ethnoepidemiology of postnatal depression, The British Journal of Psychiatry 184; 34-40
[20] Comport, M 1987.
[21] Alzheimer’s Society, 2007, Dementia UK, Summary of Key Findings
[22] Alzheimer’s Society, 2007, Dementia UK, Summary of Key Findings
[23] Alzheimer’s Society 2005, available at http://www.alzheimers.org.uk/News_and_Campaigns/Policy_Watch/demography.htm
[24] Alzheimer’s Society, 2007, Dementia UK, Summary of Key Findings
[25] NICE, 2007, A NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care.
[26] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[27] Stern, R. 1995, Mastering phobias - cases, causes and cures, Penguin, London.
[28] Marlowe, M. & Sugarman, P. 1997, ‘ABC of mental health: disorders of personality’ British medical journal, 315, 19 July, pp.176-179.
[29] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain.
[30] Gupta, R.D. and Guest, J.F., 2002, The British Journal of Psychiatry 180: pp 227-233
[31] Goodwin, F. & Jamison, K. 1990, Manic-depressive illness, OU Press, Oxford.
[32] Wing, J. & Marshall, P. 1994, ‘Protocol for visiting teams: standards for clinical and social care in schizophrenia’, Clinical Standards Advisory Group, quoted in Bird, L. 1999, The fundamental facts, Mental Health Foundation.
[33] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain
[34] De Silva, P. & Rachman, S. 1992, OCD - the facts, OU Press, Oxford.
[35] NICE, 2006, Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder, The British Psychological Society and The Royal College of Psychiatrists
[36] ONS 2000, Psychiatric morbidity among adults living in private households in Great Britain
[37] Mangalore, R. and Knapp, M., 2006, Cost of Schizophrenia in England, PSSRU Discussion Paper 2376
[38] Warner, R. 1994, Recovery from schizophrenia - psychiatry and political economy, Routledge, London.
[39] Mangalore, R and Knapp, M, 2006, Cost of Schizophrenia in England, PSSRU Discussion Paper 2376

This factsheet was written by Inger Hatloy and last updated March 2008.