Interdisciplinary Review of General, Forensic, Prison and Military Psychiatry and Psychology and the related subjects of Behavior and Law with the occasional notes and comments by Michael Novakhov, M.D. (Mike Nova).
Friday, August 3, 2012
Mental health metrics: the misery map | Editorial - via Comment is free | guardian.co.uk by on 8/2/12
Mental health is one of those subjects on which there are more strongly-held than well-informed opinions
Like the costs and benefits of staging the Olympics, or behavioural differences between boys and girls, mental health is one of those subjects on which there are more strongly-held than well-informed opinions. One problem is that such hard facts as there are can be twisted to fit every prejudice. New figures on antidepressant prescriptions confirm a runaway rise that has now pushed use up by 500% in 20 years. But what exactly does this prove?
For the stiff upper-lip brigade it is another sign of post-Diana national decline – of people mistaking life's slings and arrows for a pathology, and of soft-hearted physicians pandering to them. Kinder souls will regard the news as a welcome sign of an old taboo fading – evidence of patients, who would once have suffered from a crippling condition in silence, finally having the confidence to come forward and get help. Those with faith in scientific progress will discern GPs getting better at diagnosing and pharmaceutical companies producing smarter drugs. Materialists preoccupied with the economy will notice that last year's 9.1% rise exceeds the 6.8% average over the past decade – and blame the double dip.
So we can't settle arguments about the meaning of medicated misery by simply counting prescriptions. If we map them, however, we start to get a few insights. The BBC's Mark Easton shrewdly spotted that Blackpool, which topped the antidepressant chart, was also the lowest-scoring English town on happiness, as measured by the official life satisfaction survey released the week before. Scotland's Highlands and Islands boasted the broadest smiles in that data, and – sure enough – separate Scottish statistics confirm antidepressants are rarer in these corners of the kingdom too. The fit between self-rated misery and prescriptions for depression suggests, first of all, that both are measuring something real.
A deep north-south divide in prescriptions is, in part, a reminder that unemployment hurts. Redcar, Gateshead and Newcastle are all near the top of this table, and all have far more than their share of jobseeker's allowance claims. But economics is not the end of the story. Conurbations further south – from Birmingham to inner-London – are often also short on jobs, and yet anti-depressants are much rarer in these places, even where they have poor life satisfaction scores.
The most obvious difference between these places and the north-east is the ethnic mix. One fashionable view says too much diversity can impose strains, but here is an indicator of distress which points the other way. In truth, it is less likely to be a case of diversity vanquishing depression than a sign of continuing stigma about mental health in some immigrant communities. Mapping misery reveals a good deal about where it needs to be tackled.