Why is the psychological ability not entirely reliable

Mental illness: high incidence, low treatment rate

The psychological module of the German Health Survey finally brings to light reliable statements about prevalence and the reality of care.

Exactly 33.3 percent of the population show one or more clinically significant mental disorders on an annual basis. Surprisingly, the highest prevalences occur in young people. Women are slightly more affected by mental illness than men. However, there are considerable gender-specific differences in individual diagnoses, such as anxiety disorders and depression. Mental disorders often occur together or are associated with other illnesses. With comorbidity, the incapacity for work also increases rapidly: If a third of all people with mental disorders have "only" one day absent within four weeks, the proportion with multimorbidity rises from 63 percent (with three diagnoses) to almost 90 percent (with five Diagnoses). Only 42.9 percent of those affected by a mental illness have ever had contact with the medical system as a result. Prof. Dr. phil. Hans-Ulrich Wittchen, Dresden, for alarming (see 3 questions to...).

Overall, the population has not become "mentally sicker" in the last ten years, assured Wittchen at the congress of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN) in November 2012. The overall prevalence of a third is even a little below the in the EU with 38.2 percent. His colleague Prof. Dr. rer. nat. Frank Jacobi, Dresden / Berlin, was calm in front of the press: Mental health disorders were part of normal life. A shift in disorders can be observed, not an increase in disease.

Statements on the mental health of adults in Germany are contained in the German Health Survey (DEGS) and, above all, its “Mental Health” module. The DEGS was collected between November 2008 and December 2011 by the Robert Koch Institute (RKI) and asked about the major widespread diseases diabetes and obesity, about physical activity in adults and functional restrictions in old age, as well as about four particularly common mental disorders: stress, sleep disorders , Depression and burnout. The first results were presented in July (see PP, issue 11/2012).

Every year 33.3 percent of the population have one or more mental disorders.
Source: Robert Koch Institute Berlin

Many special evaluations

At the DGPPN congress, which took place in Berlin in November 2012, the “Mental Health” module of the survey (DEGS-MH, where MH stands for Mental Health) was presented in more detail. The RKI commissioned the Institute for Clinical Psychology and Psychotherapy at the Technical University of Dresden with this additional examination. Wittchen, the head of the institute, and his fellow student Jacobi reported together with Dr. phil. Ulfert Hapke from the Epidemiology of Non-Communicable Diseases Department of the RKI (see also www.degs-studie.de). A base publication announced for May 2013 will contain further results. The DEGS data should be publicly accessible from 2014. A large number of special evaluations can be expected. Because the abundance and quality of the data from DEGS and the additional module make the hearts of epidemiologists beat faster.

The methodology was complex. During the DEGS core examination, 8,152 representatively selected people between 18 and 79 years of age were not only questioned by two medical-led mobile teams at 180 locations spread across Germany, 7,116 of them were also physically examined, including laboratory analysis of blood and urine. The cognitive abilities of the over 64-year-olds were also tested.

The additional study "Mental Health", which ran between September 2009 and April 2012, went one better: 5,318 people from the DEGS sample were examined neuropsychologically for between 90 and 120 minutes in a standardized diagnostic interview. The aim was the differentiated clinical-diagnostic recording of mental disorders according to the criteria of recognized diagnostic systems. In addition, the need for care should be estimated. 40 clinically trained interviewers were used.

For the DEGS as well as the module, the Federal Health Survey from 1998 was also used for comparison. 3,959 people from 1998 also took part in the new survey. The RKI aims to continue such re-invitations in its future surveys - DEGS 2 and 3 are already planned - in order to arrive at “longitudinal sections” over many years.

Gaps in supply

There are already gaps in the treatment of mentally ill patients. In any case, the DEGS psychological module shows low treatment rates within one year, even for more serious disorders (e.g. alcohol abuse: 25.8 percent, obsessive-compulsive disorder 42.5 percent, phobias between 45.6 and 53 percent). Are the relatively low treatment rates due to the lack of supply? To psychiatrists, psychotherapists or general practitioners who are absent, have no time or do not notice the need for treatment? Is it because some clinical pictures are taken more seriously than others? It is striking that the treatment rates increase with the comorbidity. Does that mean it has to get “bad” before the medical system accepts the patient or the patient seeks contact? What role do disease modes play? Burnout, for example, is (as the DEGS core study shows) a disorder of socially upscale groups, while depression is more associated with a low socio-economic status.

The DEGS and the additional examination could not only provide answers to such questions, but - not least - support political demands for adequate care. Prof. Dr. med. Peter Falkai, Munich, DGPPN President until 2013, sees the data as “a special treasure for our subject”. His successor, Prof. Dr. med. Wolfgang Maier, Bonn, was a little more specific in front of the press in Berlin: The results are "important for the distribution of funds" and for the needs planning using morbidity data. So far, this has been done on the basis of population figures. If you follow Maier, that's outdated.

Norbert Jachertz