Q. I am writing a paper on the trends of psychiatry from the 1990's to present time. I am having a very difficult time finding clear facts about the increase in people using psychiatry and the distributions of problems people are seeing them for. I was wondering if you had this information or knew anywhere I could retrieve this information at?

A. The article by Olfson et al (Am J Psychiatry 2002 Nov;159(11):1914-20) should get you started. It seems clear that treatment of mood disorders and attention deficit hyperactivity disorder (ADHD) is on the increase. These researchers found that between 1987 and 1997, there was no statistically significant change in the overall rate of psychotherapy use (3.2 per 100 persons in 1987 and 3.6 per 100 in 1997). However, significant increases were observed in psychotherapy use by adults aged 55-64 years and by unemployed adults.

Among psychotherapy patients, there was a marked increase in the use of antidepressant medications (14.4% to 48.6%), mood stabilizers (5.3% to 14.5%), and stimulants (1.9% to 6.4%). (These figures are not the equivalent of diagnoses, but they tend to reflect mood disorder and ADHD diagnoses). Psychotherapy provided by physicians increased from 48.1% to 64.7%.

Interestingly, and perhaps consistent with managed care restrictions, a smaller proportion of patients made more than 20 psychotherapy visits in 1997 (10.3%) than in 1987 (15.7%). Over this period, according to Olfson et al, psychotherapy visits for mood disorders became more common.

Other data from Canada also suggest that rates of major depression are probably increasing, and that both major depression and bipolar disorder are occurring at younger ages (RC Bland, Can J Psychiatry 1997 May;42(4):367-77). This is consistent with data from the UK, finding that antidepressant prescribing has increased in all age and sex groups (Middleton et al, J Public Health Med 2001 Dec;23(4):262-7).

The authors conclude that "?this indicates either that there have been changes in the presentation, recognition and management of depression in general practice; or that the prevalence of depression has increased, or a combination of these two phenomena. The higher prescribing rate in females is in keeping with evidence from psychiatric morbidity surveys suggesting that women experience higher levels of psychiatric morbidity than men."

Good luck with this important paper!

April 2003

Disclaimer Back to Ask the Expert