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PaperclipPerfector  7mo ago (text post)   2320 thread views

Small-Scale Question Sunday for October 8, 2023

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I have a gut feeling that mental health is declining in the United States. How would I go about quantifying and gathering data that would provide evidence for/against my gut feeling?

The problem I'm running into is that I don't think the data I need is publicly available. I was thinking I should look at trends in things like:

  • Deaths of despair (drug overdoses, suicides) - this is the easiest data point to gather
  • Percent of population with a mental health diagnosis, with further breakouts by type of diagnosis
  • Number of people currently seeing a mental healthcare provider (per capita)
  • % of total population that ever saw a mental healthcare provider
  • Waitlist times for new clients seeking a mental healthcare provider
  • Percent of population not seeing a mental healthcare provider, but that indicate via survey that they have symptoms of a mental health disorder.

New Matt Yglesias blog post is about this

Interesting, thanks for sharing.

I think a good data point for determining if despair is rising would be to look at attempted suicides.

I found a Polish study, it says (based on data from General Police Headquarters of Poland)

In the analyzed age group, an increase in the number of suicide attempts has been observed over a period of 20 years (Figure 1). During recent 5 years, the number has more than doubled—from 428 in 2014 to 905 in 2019

I haven't found good US data but I think this is an interesting angle to explore.

See if there were any large cohort surveys done across the decades with questions like “would you say you are happy with your life”, “how often do you think about killing yourself”, “do you consider your life to have purpose”, “do you look forward to the future”, “how often do you feel gratitude”

IMO you can’t do “deaths of despair” because Americans have more cheap distractions now than ever, which is certainly preventing some from suicide. You can’t do mental health diagnosis because criteria changes and because of availability differences.

I found https://www.samhsa.gov/data/nsduh/national-releases there is a number in each years report like this:

Among adults aged 18 or older in 2021, 22.8% (or 57.8 million people) had any mental illness (AMI) in the past year.

In 2021, 5.5% of adults aged 18 or older (or 14.1 million people) had serious mental illness (SMI) in the past year.

I think this will be a decent way to see the trend. It is self-reported but there would be some consistency due to some of the same respondents self-reporting over multiple years.

Deaths of despair (drug overdoses, suicides) - this is the easiest data point to gather

Isn't this exactly the point of the 2015 article and subsequent media coverage that coined the term "deaths of despair"? Like, can't you just replicate the methodology, update the plots, and see if the trend continues? I guess there is the complication that the numbers would have been disrupted by COVID.

The other points are going to be really difficult to disentangle for effects from access, diagnostic criteria, population shifts, social attitudes to seeking care, etc.

Like, can't you just replicate the methodology, update the plots, and see if the trend continues?

Yes, but you need other data to give it context to determine mental health trends. For instance:

  • Are attempted suicides also rising?
  • Are non-lethal drug overdoses also rising?
  • Are more people seeking mental healthcare?

For instance, you could have a situation where deaths of despair remain stable but attempted suicides are trending higher indicating that mental health is getting worse. You can't tell from just the deaths of despair data.

"Deaths of despair" are confounded by increased use of opioids on an outpatient basis and the subsequent crackdown (leading addicts to substitute more dangerous alternatives), followed by the fentanyl boom.

Also, the other ideas OP mentioned are confounded by mental health care becoming more fashionable, greater awareness, greater access to mental health care due to increases in income, changes in insurance coverage, etc.

Finding an objective measure of mental health that's been tracked reliably over time is a very difficult problem.

IMO Angus Deaton, the guy pushing the "deaths of despair" narrative, is cashing in his Nobel credibility to push an ideological narrative that is at best one of multiple hypotheses consistent with the available evidence.

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