Healthy People 2010—Conference Edition

Chapter 18 Mental Health and Mental Disorders

Disparities

Although mental illnesses, for the most part, are equal opportunity disorders, there are some marked differences in how they present themselves and how they are prevented, diagnosed, and treated by gender, racial and ethnic group, and age.¹⁷

Differences between men and women are evident in the number of cases of particular mental disorders. For example, major depression affects approximately twice as many women as men.²⁴ Women who are poor, have little formal schooling, and are on welfare or are unemployed are more likely to experience depression than women in the general population. Anxiety, panic, and phobic disorders affect two to three times as many women as men.^{25, 26, 27}

Risk for engaging in suicidal behaviors also differs by gender. A history of physical or sexual abuse appears to be a serious risk factor for suicide attempts in both women and men.^{28, 29} Women attempt suicide more often than men,³⁰ but men’s risk of completed suicide is on average 4.5 times higher than women’s.³¹ This suicide gender gap begins in adolescence and grows through middle and later life.³²

Specific mental disorders affect men and women at particular stages of life. Schizophrenia occurs more often in young men than in women and usually has its onset in the late teen and early adult years. Eating disorders, affecting up to 2 percent of the population, arise predominantly—but not exclusively—in adolescent and young adult women (90 percent of all cases); the median age of onset is 17 years.² Eating disorders often persist into adulthood and have among the highest death rates of any mental disorder.³³ Alzheimer’s disease affects equal numbers of women and men, although women’s longer average life spans mean that more women than men have Alzheimer’s disease at any point in time.³⁴

Mental disorders, in aggregate, are as common later in life as they are at other ages, although rates for specific mental disorders vary depending on age and gender.³⁵ In any 1-year period, the number of cases of major depression in persons aged 65 years and older is approximately 1 percent, which is about half the rate among persons aged 45 to 64 years.³⁶ Depression rates are much higher, however, among older Americans who experience a physical health problem—12 percent for persons hospitalized for problems such as hip fractures or heart disease.³⁷ Depression rates for older persons in nursing homes range from 15 to 25 percent.³⁸ The number of cases of dementias, such as Alzheimer’s disease and other severe losses of mental abilities, are as high as 12 percent among persons aged 65 years and older.³⁹ By age 85 years, the rate grows to 25 percent.⁴⁰

In contrast, rates of primary psychotic disorders drop with age;⁴¹ thus, schizophrenia and persistent paranoid disorders affect fewer than 0.5 percent of older adults.⁴² Although fewer old persons attempt suicide than do young persons,⁴³ the rate of completed suicide is highest among elderly men, who account for about 80 percent of suicides among persons aged 65 years and older.⁴⁴ Moreover, elderly white men have a suicide rate six times the national average.⁴⁵

Caution is needed, however, when discussing differences among racial and ethnic groups in the rates of mental illness. Studies of the number of cases of mental health problems among ethnic

and racial populations, while increasing in number, remain limited and often inconclusive. Discussion of the rates of existing cases must consider differences in how persons of different cultures and racial groups perceive mental illness. Behavioral problems that Western medicine views as signs of mental illness may be assessed differently by individuals in various ethnic and racial groups. With this caution in mind, along with the recognition that sample sizes for ethnic and racial groups may be limited, examination of existing large-scale studies for mental health trends among ethnic and racial groups of Americans remains important.

Mental disorders are not only the cause of limitations of various life activities but also can be a secondary problem among people with other disabilities. Depression and anxiety, for example, are seen more frequently among people with disabilities than those without disabilities.⁴⁶

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