Mental disorders, also known as mental health conditions, are characterized by clinically significant disturbances in an individual’s cognition, emotional regulation, or behavior. These conditions are typically associated with distress or impairment in crucial areas of functioning. It’s important to understand that mental health is a broad spectrum, encompassing mental disorders, psychosocial disabilities, and other mental states that can cause considerable distress, functional impairment, or risk of self-harm. This article focuses specifically on mental disorders as defined by the International Classification of Diseases 11th Revision (ICD-11), offering insights into common psychiatric diagnoses.
In 2019, a staggering 1 in 8 people globally – approximately 970 million individuals – were living with a mental disorder. Anxiety and depressive disorders were identified as the most prevalent (1). The COVID-19 pandemic in 2020 further exacerbated this situation, leading to a significant surge in cases of anxiety and depression. Initial estimates indicated a dramatic 26% and 28% increase in anxiety and major depressive disorders, respectively, within a single year (2). Despite the availability of effective prevention and treatment options, a significant portion of individuals with mental disorders lack access to adequate care. Furthermore, many face stigma, discrimination, and human rights violations.
Anxiety Disorders: Recognizing Excessive Fear and Worry
Anxiety disorders are a Common Psychiatric Diagnosis, affecting 301 million people worldwide in 2019, including 58 million children and adolescents (1). These disorders are defined by excessive fear, worry, and related behavioral disturbances. The symptoms are severe enough to cause significant distress or impair daily functioning. Several distinct types of anxiety disorders are recognized:
- Generalized Anxiety Disorder (GAD): Characterized by persistent and excessive worry about various topics, events, or activities.
- Panic Disorder: Marked by recurrent, unexpected panic attacks, which are sudden periods of intense fear that can include physical symptoms like heart palpitations, shortness of breath, and dizziness.
- Social Anxiety Disorder (Social Phobia): Involves intense fear and worry in social situations, often driven by concerns about being judged or scrutinized by others.
- Separation Anxiety Disorder: Characterized by excessive fear or anxiety related to separation from attachment figures – individuals to whom a person has a deep emotional bond.
Effective psychological treatments are available for anxiety disorders, and in some cases, depending on age and severity, medication may also be recommended.
Depression: Understanding Persistent Sadness and Loss of Interest
Depression is another prevalent common psychiatric diagnosis, with 280 million people affected globally in 2019, including 23 million children and adolescents (1). It’s crucial to differentiate depression from normal mood fluctuations and temporary emotional responses to life’s challenges. A depressive episode is characterized by persistent depressed mood (feeling sad, irritable, or empty) or a marked loss of pleasure or interest in nearly all activities, occurring for most of the day, almost every day, for at least two weeks. Additional symptoms can include:
- Difficulty concentrating
- Feelings of excessive guilt or low self-worth
- Hopelessness about the future
- Thoughts of death or suicide
- Sleep disturbances
- Changes in appetite or weight
- Fatigue and low energy
Individuals experiencing depression have an elevated risk of suicide. Fortunately, effective psychological treatments exist, and medication can be a beneficial option depending on individual needs and the severity of the condition.
Bipolar Disorder: Navigating Mood Swings Between Highs and Lows
Bipolar disorder affected 40 million people in 2019 (1). This condition is characterized by significant mood swings, alternating between depressive episodes and periods of manic symptoms. Depressive episodes in bipolar disorder share the same characteristics as described above for depression. Manic symptoms, on the other hand, involve an elevated or irritable mood, increased energy levels, and other symptoms such as:
- Increased talkativeness
- Racing thoughts
- Inflated self-esteem
- Decreased need for sleep
- Distractibility
- Impulsive and reckless behavior
Similar to depression, individuals with bipolar disorder face an increased risk of suicide. Effective treatment strategies include psychoeducation, stress management techniques, strengthening social functioning, and medication.
Post-Traumatic Stress Disorder (PTSD): Addressing Trauma’s Impact
The prevalence of PTSD and other mental disorders is notably higher in conflict-affected regions (3). PTSD can develop after exposure to an extremely threatening or horrific event or series of events. The core features of PTSD include:
- Re-experiencing the Trauma: Intrusive memories, flashbacks, or nightmares that bring the traumatic event into the present.
- Avoidance: Efforts to avoid thoughts, memories, activities, situations, or people that are reminders of the trauma.
- Persistent Perception of Threat: Ongoing feelings of heightened danger and threat in the present.
These symptoms must persist for at least several weeks and cause significant functional impairment to warrant a PTSD diagnosis. Effective psychological treatments are available to help individuals recover from PTSD.
Schizophrenia: Understanding Perception and Behavioral Changes
Schizophrenia affects approximately 24 million people worldwide, or 1 in 300 individuals (1). People with schizophrenia have a significantly reduced life expectancy, 10-20 years shorter than the general population (4). Schizophrenia is characterized by substantial disruptions in perception and changes in behavior. Symptoms can include:
- Persistent delusions (false beliefs)
- Hallucinations (sensory experiences in the absence of external stimuli)
- Disorganized thinking
- Highly disorganized behavior or catatonia (extreme agitation or slowing of movement)
Individuals with schizophrenia may also experience persistent cognitive difficulties. A range of effective treatment options are available, including medication, psychoeducation, family interventions, and psychosocial rehabilitation.
Eating Disorders: Addressing Disordered Eating and Body Image Concerns
In 2019, 14 million people experienced eating disorders, including nearly 3 million children and adolescents (1). Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating patterns, an excessive preoccupation with food, and significant concerns about body weight and shape. These symptoms and behaviors lead to significant health risks, distress, or functional impairment.
- Anorexia Nervosa: Often begins in adolescence or early adulthood and is associated with a high risk of premature death due to medical complications or suicide.
- Bulimia Nervosa: Individuals with bulimia nervosa have a significantly increased risk of substance use disorders, suicidality, and other health complications.
Effective treatment options include family-based therapy and cognitive-behavioral therapy.
Disruptive, Impulse-Control and Conduct Disorders
Conduct-dissocial disorder, also known as conduct disorder, affected 40 million people, including children and adolescents, in 2019 (1). This disorder, along with oppositional defiant disorder, falls under the category of disruptive, impulse-control and conduct disorders. These disorders are characterized by persistent behavioral problems, including defiance, disobedience, and behaviors that violate the basic rights of others or major age-appropriate societal norms or laws. These disorders commonly emerge during childhood, though not always. Effective psychological treatments often involve parents, caregivers, and teachers, and may include cognitive problem-solving or social skills training.
Neurodevelopmental Disorders: Conditions Emerging in Development
Neurodevelopmental disorders are cognitive and behavioral disorders that arise during the developmental period. They involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions.
Key examples of neurodevelopmental disorders include:
- Intellectual Developmental Disorders: Characterized by significant limitations in both intellectual functioning and adaptive behavior, impacting everyday conceptual, social, and practical skills.
- Autism Spectrum Disorder (ASD): A diverse group of conditions characterized by challenges in social communication and interaction, along with restricted, repetitive patterns of behavior, interests, or activities.
- Attention-Deficit/Hyperactivity Disorder (ADHD): Characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that negatively impacts academic, occupational, or social functioning.
Effective treatment options for neurodevelopmental disorders include psychosocial interventions, behavioral therapies, occupational therapy, and speech therapy. In certain cases and for specific age groups, medication may also be considered.
Risk Factors for Mental Disorders
A complex interplay of individual, family, community, and structural factors can influence mental health. While most individuals exhibit resilience, those exposed to adverse circumstances, such as poverty, violence, disability, and inequality, are at a heightened risk of developing mental disorders. Risk and protective factors encompass individual psychological and biological elements, like emotional skills and genetics. Many of these factors exert their influence through alterations in brain structure and/or function.
Addressing Gaps in Mental Health Care
Health systems worldwide are often inadequately equipped to meet the needs of individuals with mental disorders, frequently suffering from under-resourcing. A significant gap exists globally between the need for mental health treatment and its provision, and the quality of care when available is often suboptimal. For instance, only 29% of people with psychosis (5) and just one-third of individuals with depression receive formal mental health care (6).
Beyond medical treatment, people with mental disorders require comprehensive social support, including assistance in building and maintaining personal, family, and social relationships. Support for educational pursuits, employment, housing, and participation in meaningful activities is also crucial.
WHO’s Commitment to Mental Health
The World Health Organization (WHO) recognizes the critical role of mental health in achieving overall health for all individuals, as outlined in its Comprehensive Mental Health Action Plan 2013-2030. The plan sets forth four major objectives:
- Strengthening effective leadership and governance for mental health.
- Providing comprehensive, integrated, and responsive mental health and social care services within community-based settings.
- Implementing strategies for mental health promotion and prevention.
- Strengthening information systems, evidence, and research related to mental health.
The WHO’s Mental Health Gap Action Programme (mhGAP) utilizes evidence-based technical guidance, tools, and training programs to expand mental health services in countries, particularly in resource-limited settings. mhGAP prioritizes a specific set of conditions and focuses on capacity building for non-specialized healthcare providers, promoting an integrated approach to mental health care at all levels. The WHO mhGAP Intervention Guide 2.0 is a key component of this program, offering guidance to doctors, nurses, and other healthcare workers in non-specialist settings on the assessment and management of mental disorders.
References
(1) Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), (https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).
(2) Mental Health and COVID-19: Early evidence of the pandemic’s impact. Geneva: World Health Organization; 2022.
(3) Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394,240–248.
(4) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10,425-438.
(5) Mental health atlas 2020. Geneva: World Health Organization; 2021
(6) Moitra M, Santomauro D, Collins PY, Vos T, Whiteford H, Saxena S, et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: a systematic review and Bayesian meta-regression analysis. PLoS Med. 2022;19(2):e1003901. doi:10.1371/journal.pmed.1003901.
