Survey shows one in three adults with common mental disorders report using treatment services

29 September 2016: One in three adults (37 per cent)² aged 16-74, with conditions such as anxiety or depression, surveyed³ in England, were accessing mental health treatment in 2014.

The results of the Survey of Mental Health and Wellbeing⁴, published today by NHS Digital, show that this figure has increased from one in four people (24 per cent) since the last survey was carried out in 2007.

Overall, around one in six adults (17 per cent) surveyed in England met the criteria for a common mental disorder (CMD)⁵ in 2014.

The Adult Psychiatric Morbidity Survey - Survey of Mental Health and Wellbeing, England, 2014⁶ provides statistics on the prevalence of both treated and untreated psychiatric conditions among adults aged 16 and over, in England.

The survey was carried out for NHS Digital by the National Centre for Social Research (NatCen) in collaboration with the University of Leicester. It provides context for understanding mental health and supports clinical research and funding by examining the prevalence of mental health conditions and behaviours and how they vary by factors such as gender, age, ethnic group and marital status.

The report also showed, for the people surveyed:

• Women were more likely than men to have reported CMD symptoms. One in five women (19 per cent) had reported CMD symptoms, compared with one in eight men (12 per cent). Women were also more likely than men to report severe symptoms of CMD - 10 per cent of women surveyed reported severe symptoms compared to 6 per cent of men
• The gap in reported rates of CMD symptoms between young men and women has increased since the first time the survey was carried out. In 1993, 19 per cent of 16 to 24 year old women surveyed reported symptoms of CMD compared to 8 per cent of 16 to 24 year old men. In 2014, CMD symptoms were almost three times as commonly reported by women of that age range (26 per cent) than men (9 per cent)
• Medication was the most common form of mental health treatment for all conditions assessed within the survey and was reported as being taken by 10 per cent of all people interviewed. 3 per cent reported receiving psychological therapy. Medication was more common than psychological therapy both in those with current symptoms of CMD (31 per cent with medication and 12 per cent with therapies) and in those without current symptoms. (6 per cent with medication and 1 per cent with therapies)
•  Of those people reporting severe CMD symptoms there has been an increase in the proportion who reported accessing psychological therapy from 13 per cent in 2000 to 15 per cent in 2007 and 18 per cent in 2014

The report is the latest in a series of surveys which took place previously in 1993, 2000 and 2007. It includes mental health data which are not collected anywhere else and complements the wide range of statistics routinely published on mental health by NHS Digital.

The report features chapters on: common mental disorders, mental health treatment and service use, post-traumatic stress disorder, psychotic disorder, autism, personality disorder, attention-deficit/hyperactivity disorder, bipolar disorder, alcohol, drugs, suicidal thoughts, suicide attempts and self-harm and comorbidity.

Information published in the report includes:

Post-Traumatic Stress Disorder⁷:

• About a third (31 per cent) of adults surveyed reported having experienced at least one traumatic event
• Among women, the likelihood of screening⁸ positive for PTSD was high among 16 to 24 year olds (13 per cent) and then declined with age. In men, the rate remained relatively consistent for age groups between 16 and 64, (between 4 and 5 per cent for these age groups) only declining in much later life

Bipolar⁹ (included for the first time):

• Before APMS 2014, bipolar disorder had not been assessed in the UK general population
• Overall, 2 per cent of those surveyed screened positive for bipolar disorder, with similar rates of around 2 per cent for both men and women
• Positive screening for bipolar disorder was more common in younger age-groups. 3 per cent of 16 to 24 year olds screened positive compared with less than 1 per cent of those aged 65 to 74. None of the participants aged 75 and over screened positive for bipolar disorder. These were small numbers of individuals and the rates for specific age groups in the overall population may vary from these, but the overall reduction of rate with age was found to be statistically significant

Suicidal thoughts, suicide attempts and self-harm among those surveyed¹⁰:

• A fifth of adults (21 per cent) reported that they had thought of taking their own life at some point
• Overall, half of people who had attempted suicide had sought help after their most recent attempt (50 per cent)
• The proportion of the population who report having self-harmed has increased from 2 per cent of 16 to 74 year olds in 2000 to 4 per cent in 2007, and 6 per cent in 2014. This increase is evident in both men and women and across age-groups
• One in four 16 to 24 year old women (26 per cent) surveyed has self-harmed, more than twice the rate than in young men (10 per cent). This mostly took the form of self-cutting

Comorbidity¹¹:

• For the first time, the 2014 survey profiled comorbidity across mental disorders, chronic physical conditions, psychological wellbeing and mental disorder. The five chronic conditions considered were asthma, high blood pressure, diabetes, cancer and epilepsy
• There was an association between common mental disorders (CMD) and chronic physical conditions. Over a third (38 per cent) of people surveyed with severe CMD symptoms reported a chronic physical condition, compared with a quarter (25 per cent) of those with no or few symptoms of CMD
• The association between common mental disorder (CMD) and chronic physical conditions was evident for each of the chronic conditions examined. For example, people surveyed with severe symptoms of CMD were twice as likely to have asthma (15 per cent) as people with no or few symptoms (7 per cent)

Read the full report at: https://webarchive.nationalarchives.gov.uk/20180328130852tf_/http:/content.digital.nhs.uk/catalogue/PUB21748/

1. NHS Digital is the national information and technology provider for the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. Our vision is to harness the power of information and technology to make health and care better. NHS Digital is the new trading name for the Health and Social Care Information Centre (HSCIC). We provide 'Information and Technology for better health and care'. Find out more about our role and remit at digital.nhs.uk

2. Percentages are rounded to the nearest whole number.

3. The survey data were weighted to take account of selection probabilities and non-response, so that the results were representative of the household population aged 16 years and over. The results shown here and in the report reflect the responses received from people surveyed with this weighting applied.

4. The report is published every seven years. This is the fourth publication in the series. High quality screening and assessment tools are used and undiagnosed conditions are identified. Methods are kept comparable, so trends over time can be examined with surveys carried out in 1993, 2000, 2007 and 2014. A random sample of the household population is used, covering the whole adult age range and including people who do not use mental health services.

5. Common mental disorders (CMDs) comprise different types of depression and anxiety. The revised Clinical Interview Schedule (CIS-R) has been used on every wave of the APMS series to assess six types of CMD: depression, generalised anxiety disorder (GAD), panic disorder, phobias, obsessive compulsive disorder (OCD), and CMD not otherwise specified (CMD-NOS). Many people meet the criteria for more than one CMD. The CIS-R is also used to produce a score that reflects overall severity of symptoms of CMD. The scores for each section are then summed to produce a total CIS-R score, which is an indication of the overall severity of symptoms. A CIS-R score of 0-5, is used to denote people with few or no symptoms. A CIS-R score of 18 or more denotes more severe or pervasive symptoms of a level very likely to warrant intervention such as medication or psychological therapy.

6. Fieldwork was carried out between May 2014 and September 2015 using a two-phase approach. First, phase interviews were carried out by NatCen Social Research interviewers including structured assessments and screening instruments for mental disorders, and questions about other topics, such as general health, service use, risk factors and demographics. Second, phase interviews were carried out by clinically-trained research interviewers employed by the University of Leicester. A sub-sample of phase one respondents was invited to take part in the second phase interview to permit assessment of psychotic disorder, attention-deficit/hyperactivity disorder and autism. The assessment of these conditions requires a more detailed and flexible interview than was possible at the first phase, and the use of clinical judgement in establishing a diagnosis. As for all surveys, it should be acknowledged that prevalence rates are only estimates. If everyone in the population had been assessed the rate may be higher or lower than the survey estimate. Confidence intervals are given for key estimates in the methods chapter (Chapter 14). For low prevalence disorders, relatively few positive cases were identified. Particular attention should be given to uncertainty around these estimates and to any subgroup analysis based on these small samples. All comparisons made here and in the report have been tested and only statistically significant differences are described.

7. This presents findings about the extent of trauma and of screening positive for posttraumatic stress disorder (PTSD) in the general population. A positive screen did not mean that a disorder is necessarily present, only that there were sufficient symptoms to warrant further investigation. Traumatic events were defined as experiences that put a person -or someone close to them - at risk of serious harm or death, such as a natural disaster, a serious car accident, being raped, or a loved one dying by murder or suicide.

8. The use of validated mental disorder screens and assessments allows for identification of people with sub-threshold symptoms and those with an undiagnosed disorder. A positive screen only indicates that someone may have sufficient traits to warrant further and fuller investigation. Screen positive rates tend to be higher than actual rates of disorder. It should also be noted that the term 'screen' is used as a convention, and does not indicate that that the screening tests used in the survey are used as part of any national screening programme in England.

9. Bipolar disorder, previously known as manic depression, is a common, lifelong, mental health condition characterised by recurring episodes of depression and mania. It is associated with significant impairment. Before APMS 2014, bipolar disorder had not been assessed in the UK general population.

10. This chapter provides nationally representative estimates of the prevalence of suicidal thoughts, suicide attempts and self-harm, and trends in these since 2000. Their relationship to age, sex and other characteristics is described alongside findings on the methods and reasons reported for self-harming. Finally, results are presented on the help-seeking behaviour of people who have made a suicide attempt, and on the types of professional help received by those who have self-harmed.

11. Comorbidity refers to the presence of two or more conditions at the same time. Physical health conditions were measured by showing participants a list of health conditions and asking which a health professional had diagnosed them with. Five chronic conditions were considered. The identification of mental disorders followed the same approach as that in the mental disorder specific chapters. Mental wellbeing was assessed using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), where a higher score indicates greater psychological wellbeing. Learning impairment was also included, assessed using the New Adult Reading Test (NART).

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