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MENTAL HEALTH MATTERS Author(s): Steven K. Galson Source: Public Health Reports (1974-) , MARCH/APRIL 2009 , Vol. 124, No. 2 (MARCH/APRIL 2009), pp. 189-191 Published by: Sage Publications, Inc. Stable URL: https://www.jstor.org/stable/25682191 JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact firstname.lastname@example.org.
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is collaborating with JSTOR to digitize, preserve and extend access to Public Health Reports (1974-) This content downloaded from 220.127.116.11 on Wed, 20 Oct 2021 01:46:57 UTC All use subject to https://about.jstor.org/terms Surgeon General’s Perspectives MENTAL HEALTH MATTERS Mental health and wellness are essential to overall health. The World Health Organization defines health as “… a state of complete physical, mental, and social well-being_”l For all of us, our mental, physical, and social health are interdependent. Consider the links between chronic disease and depression. Individuals who suffer from a chronic condition such as cardiovascular disease or diabetes have a greater risk of developing a mental disorder such as depression.1 Individuals with depression have a greater risk of developing chronic diseases such as cancer.2 The issue of comorbidity?the simultaneous occurrence of two or more conditions or diseases?is gaining interest. Furthermore, recent research indicated that obese individuals have a significantly increased risk for devel oping a mood, anxiety, personality, and alcohol risk disorder.3 In this survey of 41,000 adults, the elevated risk applied to both men and women.3 In turn, individu als who are depressed may be more likely to become obese or have other poor health outcomes.4 While mental illness can be an isolating and personal struggle, it is also a public health issue. We as a soci ety need to view mental disorders like other chronic medical conditions. They are highly treatable. For many individuals, recovery from mental disorders is possible. This message needs to be further emphasized to combat stigma and encourage more people to seek treatment. Mental illness can weave itself through all aspects of one’s life: physical health, parenting, work, childbear ing, finances, caregiving, and common daily activities. An estimated 46.4yb R I $ P H U L F D Q V Z L O O H [ S H U L H Q F H V R P e form of mental illness in their lifetime.5 Given a current U.S. population of more than 305 million, that figure represents an estimated 141 million of us. It does not include those affected by the mental illness of their spouses, parents, friends, children, or grandparents. In the U.S., these disorders cost billions of dollars in direct health costs and indirect costs: decreased pro ductivity, absenteeism, lost jobs and wages, untold pain and suffering, unraveling of families and friendships, and suicide. Various forms of depression are estimated to cost more than $83 billion a year.6 Anxiety disorders, which affect roughly 40 million American adults,7 cost more than $63 billion a year.6 RADM Steven K. Galson, Acting Surgeon General More than a decade of research tackling sex and gen der differences in mental health has revealed insights that should influence how we manage these conditions. For major depressive disorder, 20.0yb R I Z R P H Q D U e affected vs. 13.0yb R I P H Q 0 R U H W K D Q \b of women will suffer from panic disorder compared with 3.1yb R f men. Women suffer from post-traumatic stress disorder (PTSDyf D W P R U H W K D Q W Z R W L P H V W K H U D W H R I P H Q \b for women vs. 3.6yb R I P H Q : R P H Q U H S U H V H Q W \b of all cases of eating disorders, which have the highest mortality rate of all mental disorders.9 Men have higher rates of impulse-control disorders and substance abuse disorders than do women. Almost 10.0yb R I P H Q K D Y H D W W H Q W L R Q G H I L F L W K \ S H U D F W L Y L W \ G L s order compared with 6.4yb R I Z R P H Q 1 H D U O \ \b of men suffer from alcohol abuse, compared with 7.5yb of women. Of men, 11.6yb D U H D I I H F W H G E \ G U X J D E X V e vs. 4.8yb R I Z R P H Q 8 Males commit suicide at nearly four times the rate of females. However, women attempt suicide roughly two to three times as often as men.10 Men and women do have similar prevalence rates for some mental illnesses, as is the case with bipolar disorder.8 Yet notable differences exist in the presentation and course of these same ill nesses. For example, women tend to have a later age of onset of bipolar disorder than men, and they are Public Health Reports / March-April 2009 / Volume 124 O 189 This content downloaded from 18.104.22.168 on Wed, 20 Oct 2021 01:46:57 UTC All use subject to https://about.jstor.org/terms 190 O Surgeon General’s Perspectives more likely than men to experience a seasonal pattern of the mood disturbance.11 Important biological differences between men and women, such as hormones and brain structure, may affect the risk of developing certain mental disorders. Environmental factors may also be associated with sex-based variations in the risk, diagnosis, course, and treatment of selected mental illnesses. Examples of such factors include trauma and violence, gender roles, treatment-seeking behaviors, poverty, social status, and coping mechanisms. Mental health issues are not fully recognized by many policy makers, health-care providers, payers, and members of the general public. Mental disorders are too often untreated, underdiagnosed, misdiagnosed, ignored, stigmatized, and dismissed. Conducting research, developing treatment strate gies, and translating those findings into practice can help us prevent, manage, and detect mental illness. Correctly diagnosing and treating mental illness can mean life or death to an individual. Recognizing that reality, the Office of the Surgeon General has a 10-year history of work on mental health issues, starting with the publication of Mental Health: A Report of the Sur geon General in 1999.12 Additional Surgeon General publications provide evidence-based information on preventing suicide,13 on children14 (youth violence15 and child maltreatment16yf R Q Z R P H Q D Q G R Q U D F L D l and ethnic populations.18 In April 2002, the President’s New Freedom Com mission on Mental Health was established.19 The Com mission identified policies that could be implemented by federal, state, and local governments to better serve adults with a serious mental illness and children with serious emotional disturbances. In January 2009, the U.S. Department of Health and Human Services (DHHSyf S X E O L V K H G $ F W L R Q 6 W H S V I R r Improving Women’s Mental Health.2 It combines the latest science of mental health with specific action steps for improving the mental health and well-being of women and girls. The document explores the sex-based dif ferences in the risk, onset, course, and treatment of mental disorders. Action Steps was supported by the DHHS Office on Women’s Health (OWHyf H V W D E O L V K H G L Q 1 to improve the health of women. OWH has since expanded its charge to include girls. OWH provides national leadership to promote health equity for women and girls through sex- and gender-specific approaches. Women’s mental health is an essential part of their overall health. That concept serves as the overarching theme of Action Steps. The report proposes the follow ing actions, among others: Integrate mental health services into primary care. Accelerate gender-based research on mental health. Recognize the unique prevalence of trauma, violence, and abuse in the lives of women and girls. Build resilience and protective factors to aid recovery. Incorporate gender differences, including mental health issues, into emergency preparedness plan ning, training, and response. The companion piece to Action Steps is entitled Women !s Mental Health: What it means to you.20 It targets a general audience with clear, concise, and visually interesting information. Its overall tone is positive, pro moting good mental health throughout a woman’s life span. Fear, stigma, trauma, and resiliency are addressed, as is the importance of seeking treatment. These two publications represent a collaborative effort of experts across DHHS. I want to acknowledge those efforts on behalf of the Office of the Surgeon General. Special thanks go to the employees of OWH for their work. As our society better understands the critical role of sex and gender in mental illness, we all benefit: women, girls, men, and boys. We have made progress in our research, in the translation of that research into practice, and in our understanding of mental health disorders. We have much more to learn and much more compassion to show. We can, and should, be role models and lead the effort to improve the mental health of Americans. The author thanks Barbara B. Disckind, DHHS Office on Women’s Health, for her contributions to this article. Steven K. Galson, MD, MPH RADM, USPHS Acting Surgeon General For reports and other resources, go to www.surgeongeneral.gov and the two websites sponsored by the DHHS Office on Women’s Health: www.womenshealth.gov and www.girlshealth.gov. To order or download the two Action Steps documents on women’s mental health, go to http://www.samhsa.gov/shin. For copies, call toll-free at 1-877-726-4727. Public Health Reports / March-April 2009 / Volume 124 This content downloaded from 22.214.171.124 on Wed, 20 Oct 2021 01:46:57 UTC All use subject to https://about.jstor.org/terms Surgeon General’s Perspectives O 191 REFERENCES 1. World Health Organization. Investing in mental health. Geneva: World Health Organization; 2003. Also available from: URL: http:// www.emro.who.int/mnh [cited 2008 Oct 8]. 2. Department of Health and Human Services (USyf $ F W L R Q V W H S V I R r improving women’s mental health [cited 2008 Oct 2]. Available from: URL: http://www.samhsa.gov/shin 3. Barry D, Pietrzak RH, Petry NM. Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Ann Epidemiol 2008;18:458-66. Also available from: URL: http://www.annalsofepidemiology.org/article/S1047 2797(08yf D E V W U D F W > F L W H G ‘ H F @ . 4. Markowitz S, Friedman MA, Arent SM. Understanding the relation between obesity and depression: causal mechanisms and implica tions for treatment. Clinical Psychology: Science and Practice 2008;15:1-20. Also available from: URL: http://www3.interscience .wiley.com/journal/119412257/issue [cited 2008 Nov 1]. 5. Kessler RC, Berglund PA, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and ageofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication [published erratum appears in Arch Gen Psychiatry 2005;62:768]. Arch Gen Psychiatry 2005;62:593-602. Also available from: URL: http://archpsyc.ama-assn.org/cgi/content/full/62/6/593 [cited 2008 Dec 10]. 6. Langlieb AM, Kahn JP. How much does quality mental health care profit employers? J Occup Environ Med 2005;47:1099-109 [cited 2008 Dec 10]. Available from: URL: http://www.ncbi.nlm.nih.gov/ sites/entrez 7. National Institutes of Health, National Institute of Mental Health. Anxiety disorders [cited 2008 Dec 10]. Available from: URL: http://www.nimh.nih.gov/health/publications/anxiety-disorders/ complete-publication.shtml 8. National Comorbidity Survey Replication (NCS-Ryf 7 D E O H / L I H W L P e prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort (n=9282yf > W D E O H F R Q W D L Q V X S G D W H G G D W D D V R I – X O @ > F L W H d 2008 Dec 10]. Available from: URL: http://www.hcp.med.harvard .edu/ncs 9. Keel PK, Herzog DB. Long-term outcome, course of illness, and mortality in anorexia nervosa, bulimia nervosa, and binge eating disorder. In: Brewerton TD, editor. Clinical handbook of eating disorders: an integrated approach. New York: Informa HealthCare; 2004. p. 97-116. Also available from: URL: http://books.google .com/books?id=YGX31uPHXqEC&printseo=frontcover#PPPl,Ml [cited 2008 Dec 16]. 10. Department of Health and Human Services, Centers for Disease Control and Prevention (USyf 6 X L F L G H ) D F W V D W D J O D Q F H 6 X P P H r 2008 [cited 2008 Dec 10]. Available from: URL: http://www.cdc .gov/ncipc/dvp/Suicide/suicide_data_sheet.pdf 11. Arnold LM. Gender differences in bipolar disorder. Psychiatr Clin North Am 2003;26:595-620. 12. Department of Health and Human Services, Office of the Surgeon General (USyf 0 H Q W D O K H D O W K D U H S R U W R I W K H 6 X U J H R Q * H Q H U D l (1999yf > F L W H G ‘ H F @ $ Y D L O D E O H I U R P 8 5 / K W W S Z Z w .surgeongeneral.gov/library/mentalhealth/home.html 13. Department of Health and Human Services, Office of the Surgeon General (USyf 7 K H 6 X U J H R Q * H Q H U D O V F D O O W R D F W L R Q W R S U H Y H Q t suicide (1999yf > F L W H G ‘ H F @ $ Y D L O D E O H I U R P 8 5 / K W W S / www.surgeongeneral.gov/library/calltoaction 14. Department of Health and Human Services, Office of the Surgeon General (USyf 5 H S R U W R I W K H 6 X U J H R Q * H Q H U D O V & R Q I H U H Q F H R n Children’s Mental Health: A National Action Agenda (2001yf > F L W H d 2008 Dec 10]. Available from: URL: http://www.surgeongeneral .gov/topics/cmh 15. Department of Health and Human Services, Office of the Surgeon General (USyf < R X W K Y L R O H Q F H D U H S R U W R I W K H 6 X U J H R Q * H Q H U D l (2001yf > F L W H G ‘ H F @ $ Y D L O D E O H I U R P 8 5 / K W W S Z Z w .surgeongeneral.gov/library/youthviolence/youvioreport.html 16. Department of Health and Human Services, Office of the Surgeon General (USyf 3 U R F H H G L Q J V R I W K H 6 X U J H R Q * H Q H U D O V : R U N V K R p on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Health Approach (2005yf [cited 2008 Dec 10]. Available from: URL: http://www.surgeonge neral.gov/topics/childmaltreatment 17. Department of Health and Human Services, Office of the Surgeon General (USyf 5 H S R U W R I W K H 6 X U J H R Q * H Q H U D O V : R U N V K R S R Q : R m en’s Mental Health (2005yf > F L W H G ‘ H F @ $ Y D L O D E O H I U R P 8 5 / : http://www.surgeongeneral.gov/topics/womensmentalhealth 18. Department of Health and Human Services, Office of the Sur geon General (USyf 0 H Q W D O K H D O W K F X O W X U H U D F H D Q G H W K Q L F L W \ . A supplement to mental health: a report of the Surgeon General (2001yf > F L W H G ‘ H F @ $ Y D L O D E O H I U R P 8 5 / K W W S Z Z w .surgeongeneral.gov/library/mentalhealth/cre 19. President’s New Freedom Commission on Mental Health. Achieving the promise: transforming mental health care in America (2003yf [cited 2008 Oct 9]. Available from: URL: http://www.mentalhealth commission .gov/ reports/FinalReport/ toe .html 20. Department of Health and Human Services (USyf : R P H Q V P H Q W D l health: what it means to you [cited 2008 Oct 2]. Available from: URL: http://www.samhsa.gov/shin Public Health Reports / March-April 2009 / Volume 124 This content downloaded from 126.96.36.199 on Wed, 20 Oct 2021 01:46:57 UTC All use subject to https://about.jstor.org/terms