
Enduring Mental Health: Prevalence and Prediction - aw1621107
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304549/
======
aw1621107
Abstract:

> We review epidemiological evidence indicating that most people will develop
> a diagnosable mental disorder, suggesting that only a minority experience
> enduring mental health. This minority has received little empirical study,
> leaving the prevalence and predictors of enduring mental health unknown. We
> turn to the population-representative Dunedin cohort, followed from birth to
> midlife, to compare people never-diagnosed with mental disorder (N = 171;
> 17% prevalence) to those diagnosed at 1–2 study waves, the cohort mode (N =
> 409). Surprisingly, compared to this modal group, never-diagnosed Study
> members were not born into unusually well-to-do families, nor did their
> enduring mental health follow markedly sound physical health, or unusually
> high intelligence. Instead, they tended to have an advantageous
> temperament/personality style, and negligible family history of mental
> disorder. As adults, they report superior educational and occupational
> attainment, greater life satisfaction, and higher-quality relationships. Our
> findings draw attention to “enduring mental health” as a revealing
> psychological phenotype and suggest it deserves further study.

~~~
epicureanideal
> Instead, they tended to have an advantageous temperament/personality style,
> and negligible family history of mental disorder. As adults, they report
> superior educational and occupational attainment, greater life satisfaction,
> and higher-quality relationships.

———-

I assume they adjusted for this, but this is funny at a surface level reading.
People with superior educational attainment, greater life satisfaction, and
higher quality relationships have fewer mental health issues. Who would’ve
thought?!

Another take: we have medicalized the normal human range of human emotions to
the point that 83% of the population will at some point be considered to have
a mental disorder.

~~~
usgroup
I think that they argue that the causality works the other way around.

All men are mortal doesn’t mean all mortals are men.

------
klft
Summary:

Study was done with a largely Caucasian, New Zealand cohort born in the 1970s.

Factors which correlate with enduring mental health:

Childhood factors:

\- little evidence of strong negative emotions

\- social support and sociability

\- self-control

Familiy environment factors:

\- fewer first- and second-degree relatives with mental health issues

\- less negative discipline

\- reduced likelihood of parental loss

Not relevant:

\- socioeconomic advantage

\- perinatal complications

\- physical health

\- intelligence

------
raziel2p
I know that in my close group of friends more than half have opened up about
dealing with depression but that it might be that way for the general
population is counter-intuitive to me. It makes sense when you think about it,
though: Obviously the couple walking down the street are going to seem happy,
and all the acquaintances you see once a month won't be the ones opening up to
you.

------
usgroup
It feels anecdotally correct. Consider things like depression as a result of
bereavement or child birth (for women). Insomnia , anxiety , etc. So many ways
to be “mentally ill” temporarily.

That said it does seem that the extreme prevalence of something over a long
period of time makes dubious the claim that it is a “mental illness”.

It feels like treating people as defective for falling over because they don’t
have 3 legs ...

~~~
__s
It might not even be indication of over diagnosis. Everyone gets physically
ill sometimes

~~~
usgroup
that's a good point if the two are comparable.

------
roenxi
The entire field o mental health revolves around the idea that there is some
sort of 'this is how brains are meant to work'. In extreme cases that works
well (eg, lead poisoning), in edge cases there is a lot of grey.

One uncomfortable part of mild depression is the questions around how correct
it is. It is easy to logically deduce depression as a rational response to the
world.

~~~
vharuck
The field of mental health says something is a disorder if it causes a
noticeable and real problem. It's a beautifully simple idea: "Is it causing a
problem? If yes, let's help. If no, leave well enough alone."

Quoting Wikipedia's summary (can't find my DSM-IV):

>According to DSM-IV, a mental disorder is a psychological syndrome or pattern
which is associated with distress (e.g. via a painful symptom), disability
(impairment in one or more important areas of functioning), increased risk of
death, or causes a significant loss of autonomy; however it excludes normal
responses such as grief from loss of a loved one, and also excludes deviant
behavior for political, religious, or societal reasons not arising from a
dysfunction in the individual.

[https://en.wikipedia.org/wiki/Mental_disorder](https://en.wikipedia.org/wiki/Mental_disorder)

We can argue about where to draw the line for distress or disability, but I
just wanted to counter the myth that shrinks are totally subjective.

------
ojnabieoot
Comments here are predictably (and depressingly) misstating this research as
"medicalizing normal emotions." This is due to two widespread misconceptions:

1) A refusal to distinguish between mental illness and permanent psychological
disability (along with the idea that all mental illnesses are neurostructural
in nature)

2) A refusal to acknowledge that "biologically normal" human emotions can
nevertheless be a cause for medical concern, in the sense that a high fever is
a "normal" and necessary response to infection that can nevertheless cause
serious problems.

If someone is deeply depressed after their mother dies, they should be
considered as having a mental injury that should heal on its own but needs to
be monitored for "infection" or otherwise problematic healing. Saying ahead of
time "this person isn't mentally ill so this is just normal bereavement" is
bad medicine and bad science.

US society in particular (but also humans in general) really wants to draw a
distinction between "the mentally ill" and "the mentally well." If you were to
try to draw a similarly strong distinction between "people with stomach
problems" and "people without stomach problems" the absurdity would be self-
evident: there is no reason to lump people with norovirus in with people with
IBD. But because mental illness is so much more mysterious (and, frankly,
scary), and so entwined with social and societal expectations and norms, it is
much harder to approach it from the same medical-first perspective.

~~~
DubiousPusher
> (along with the idea that all mental illnesses are neurostructural in
> nature)

I agree with everything you said except I'm having trouble with this bit.
Neurostructural as opposed to what? All thoughts are physical things happening
in the head.

The brain changes. Sometimes it changes to a state that creates problems for a
person (perhaps long term depression spurred by grieving a loved one.)
Sometimes talk or time can change it back. Or change it to another state that
isn't impaired by ticks or grief or anger. But it is a physical process.

I understand that sometimes working at the granular level of neurons or
chemistry isn't as productive as working at the psychological level. i.e.
sometimes talking about emotions can get the brain to start to encourage
different pathways that will eventually become the norm and take one away from
the problematic ones. But this is still a neurostructural change in the brain.
It is just mediated by the brain itself.

Perhaps I am missing some subtle point or misinterpreting you?

~~~
ojnabieoot
No, I was being vague and you are basically correct: I really meant "occurring
due to a static abberation in the brain present since birth / puberty /
adulthood", like schizophrenia, bipolar disorder, many forms of depression,
versus something that can be induced by circumstances or upbringing. Making it
more vague is, for instance, that PTSD is obviously "induced by circumstances"
but is also thought to be due to a brain injury caused by emotional trauma.

Scientifically there isn't a boundary, and I am speaking very loosely here and
probably should have said something more specific.

But "all thoughts are physical things happening in the head" is perhaps too
reductive, similar to saying "all physics is quantum mechanics" \- just
because it's true doesn't mean it's a useful way to think about a specific
problem. There's a distinct medical difference between someone with chronic
depression without a specific life event ("neurostructural"), and someone who
started out being "legitimately" depressed after being laid off, but spiralled
downwards. Both can be described as a "deficit in the structure of the brain"
but in the former case that structural deficit likely cannot be fixed by the
brain itself (even with the guidance of a therapist) and drugs are probably
necessary. In the latter case, perhaps only CBT and general wellness habits
are enough - the brain can fix its own "structural problem."

~~~
DubiousPusher
Thanks for the thoughtful reply. I grew up with a parent with severe mental
illness and a person now in my immediate family has a similar condition. So
while I've never formally studied psychiatry, psychology and neurology, I've
been submerged in the lingo, treatments, concepts and philosophies for most of
my life.

I lean heavily on the mechanisms of thought and mind because even now there is
a tremendous amount of stigma and mysticism surrounding mental illness. I've
encountered even mental health providers who still speak or act as if patients
have a failure of character or personal weakness. I've encountered specialists
who aren't really even familiar with CBT or who still think digging up trauma
repeatedly a la Freud is useful. I encounter a kind of dualism all the time,
as if the mind is some kind of sick spirit inhabiting the brain.

I agree though. Treatments can function at a more macro level. I think this is
demonstrated by something as simple as venting about a problem or person. A
resentment or regret that is stopping one up finally falls to the side when
one talks to a friend about it.

These high level concepts we have about objects and people and concepts
clearly have some power to drive the lower level. Attempting to resolve some
issue a person might have with their spouse at the neuronal level would be a
bit like building a house up from atoms rather than timber.

------
rjkennedy98
Wow could there be better evidence of medicalizing “normal” than this article

