Methodenkritik: Viel zu viel psychisch Kranke

Die US-Professoren Allan V. Horwitz (Soziologie) und Jerome Wakefield (Sozialarbeit) vertreten in einem soeben erschienen Fachartikel die Ansicht, dass die in letzter Zeit publizierten enorm hohen Zahlen von Menschen mit unbehandelten Depressionen massiv zu hoch seien. Diese Ziffern seien ein Produkt der gewählten Methodologie, die quasi zwingend zu überhöhten Zahlen führen müsse.

The High Percentages of Depression Have Been Greatly Exaggerated

The Methodology of Community Surveys Leads to an Overestimate of Mental Illness

Washington, DC—According to widely reported community-based research, almost half the U.S. population suffers from depression. But research by two sociologists indicates that percentage is greatly exaggerated or is a misrepresentation. The extraordinarily high rates of untreated mental illness reported by community studies are false, say Allan V. Horwitz, a sociology professor in the Institute of Health at Rutgers University, and Jerome Wakefield, a professor in the School of Social Work at New York University. Community studies rely on standard, closed-format questions about symptoms with no context provided to differentiate between reactions to normal life stress (i.e., a death, a romantic break up, work or school stress) and pathological conditions that indicate clinical mental illness.

Hier der Link zum Originalartikel in der Fachzeitschrift „Contexts“ im .pdf-Format (Alternativlink, falls ersterer nichts liefert). Im Weltgesundheitsbericht der WHO von 2001 steht:

Mental and behavioural disorders are estimated to account for 12% of the global burden of disease

Im Weltgesundheitsbericht von 2002 sind bei den developed countries „neuropsychiatric disorders“ (Das sind: Unipolar depressive disorders, Bipolar disorder, Schizophrenia, Epilepsy, Alcohol use disorders, Alzheimer and other dementias, Parkinson disease, Multiple sclerosis, Drug use disorders, Post-traumatic stress disorder, Obsessive-compulsive disorder, Panic disorder, Insomnia [primary], Migraine, Mental retardation [lead-caused], Other neuropsychiatric disorders) laut Grafik 4.8 für gut 20% der DALYs (ungefähr: durch Tod und Krankheit verlorene Lebensjahre) verantwortlich. Die 450 Millionen, die laut WHO an „mental or behavioural disorder“s leiden, sind 7% der Weltbevölkerung. Horwitz und Wakefield reden in ihrem Artikel eine sehr klare Sprache:

According to large, community-based research studies that the media report with great fanfare, alarming numbers of Americans suffer from mental disorders. The most frequently cited study, the National Comorbidity Survey, claims that half the population suffers from a mental illness at some point. Moreover, these same studies show that few people diagnosed as mentally ill seek professional treatment. Policy discussions, scientific studies, media reports, advocacy documents, and pharmaceutical advertisements routinely cite such figures to show that mental disorder is a public health problem of vast proportions, that few sufferers receive appropriate professional treatment, that untreated disorders incur huge economic costs, and that more people need to take medication or seek psychotherapy to overcome their suffering. Awareness of large numbers of untreated, mentally ill people in the community has reshaped mental health policy, justifying efforts to address this “unmet need for treatment”—for example, by training general practitioners or public school personnel to screen for and treat mental disorders. Despite their rhetorical value, the high rates are a fiction; the studies establish no such thing.