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Revealing the ‘icebergs’ of disease

by Guest Author on 18 Oct 2012

Vittal Katikireddi

Vittal Katikireddi

Research published today by researchers at the MRC Social and Public Health Sciences Unit has found that the mental health of many people in England has worsened since the onset of the recession in 2008. Here Vittal Katikireddi, lead author of the research, tells us why using surveys to study the health of the general population like this can reveal the disease ‘icebergs’ lurking beneath the surface.

Why bother looking at the mental health of the general population? Surely, when trying to assess the impact of an event, such as a recession, on mental health, we should only focus on the number of people who are suffering from severe mental distress or the rates of suicides? I hope to convince you otherwise.

The research we’re publishing today is based on the Health Survey for England, conducted each year between 1991 and 2010. It shows that the mental health in England has declined since the onset of the recession, particularly in men.

By studying surveys, we can uncover whose mental health has changed the most, and why, in a much more detailed way than if we were to simply look at statistics such as suicide rates. For example, our work suggests that decline in mental health cannot be explained by job loss alone, and there must be other factors at play — perhaps financial pressures or job insecurity.

Surveys also allow us to uncover the true scale of a disease in the population. Many health conditions can be thought of as an ‘iceberg’, with only the most severely affected being seen in health services and hence ‘visible’ to researchers and health professionals. But for every person who attends hospital or their GP surgery, many others may never seek treatment and hence are never diagnosed. This group of people could be far larger than those who seek treatment — they represent the ‘hidden iceberg’ of people affected by poor mental health.

Understanding both who is severely affected by studying incidences of severe mental distress or suicides and those who are affected less severely by using surveys, provides valuable and complementary information. When only a small minority of people ever become unwell from a disease, it makes sense to target our efforts. However, in the case of a common condition, taking action to improve the health of everyone in a small way could lead to the greatest health gains.

So how do we improve mental health in a recession? Good access to healthcare and other services is important. But we also need to help people who have lost their jobs, and address the stresses of financial and job insecurity amongst those still working.

As usual in science, we need to study this further. After all, the full impact of the recession may not have been felt by 2010, the end-date of this study. It seems surveys of the general public will have a continuing role to play in learning how we can best address the challenges posed to our mental health in these tough economic times.

Vittal Katikireddi

The research was published today in BMJ Open.

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