10.4: Mental Health

Mental health is a broad category that covers over 200 potential illnesses of varying severity. The mental health spectrum includes emotional, psychological, and social well-being. Mental health is influenced by genetics, biological factors like diseases or injuries, neurochemistry (chemical messengers in the brain), as well as environmental factors such as stress, adverse childhood experiences (like abuse, neglect, etc.), trauma, isolation and loneliness, and the use of drugs and alcohol. Life changes significantly impact mental health - particularly significant changes such as the death of a loved one, the end of a relationship, the birth of a child, a change in living situation, and physiological changes that occur across the lifespan such as maturation and aging. When certain symptoms of psychological distress or problematic thinking are severe or long lasting, they may be diagnosed as a mental illness. The CDC reports that over 20% of U.S. adults currently live with a mental illness, and over 20% of youth between the ages of 13-18 have experienced a debilitating mental health issue. The most serious mental illnesses include bipolar disorder, schizophrenia, and major depression, affecting about 1 in 25 adults (CDC/National Center for Injury Prevention and Control, 2024).

Mental illnesses or mental disorders cannot be diagnosed with blood tests or X-rays. Instead, these disorders are diagnosed by a cluster of symptoms - usually by a licensed psychologist or psychiatrist (the difference being only the latter type of doctor provides any prescriptions for psychiatric medications). As research continues to expand our knowledge of mental health disorders, these diagnoses are updated into a manual used by mental health professionals. The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) is the most recent iteration, published by the American Psychiatric Association. This manual includes symptoms and diagnoses for different types of psychological disorders, including:

• Neurodevelopmental disorders - such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD)
• Schizophrenia spectrum and other psychoses
• Bipolar disorders (also known as manic-depression)
• Anxiety disorders - such as generalized anxiety disorder (GAD), panic disorders, and specific phobias
• Obsessive-compulsive disorders - such as OCD, hoarding, body dysmorphic disorder
• Depressive disorders - such as major depression, dysthymic disorder, premenstrual dysphoric disorder
• Trauma and stress-related disorders - such as post-traumatic stress disorder (PTSD) or acute stress disorder
• Eating disorders - such as anorexia nervosa, bulimia nervosa, and binge-eating disorder
• Neurocognitive disorders - such as Alzheimer’s disease or cognitive impairment
• Personality disorders - such as narcissistic, antisocial, paranoid, or borderline personality disorder
• Sexual dysfunctions
• Substance-related disorders - such as addiction to alcohol, cannabis, pills, or gambling
• Other disorders such as dissociative, somatic, and impulse-control disorders (Seabert et al., 2021).

Mental disorders can occur together, and the interpretation of symptoms (and therefore diagnosis) is complicated. Accurate diagnosis and treatment is also dependent on the cultural competency of the provider to differentiate between behavioral differences that are due to socio-cultural factors vs. those caused by a mental disorder (Seabert et al., 2021). Historically, the DSM has been revised in favor of emerging evidence-based criteria in diagnostics, and to reflect the evolving understanding of socio-cultural influences on the interpretation of mental health. For example, up until the 1980s (when it was removed), homosexuality - or a reference to “sexual orientation disturbance” - was present in the DSM. And prior to the 1980s, PTSD, bipolar disorder, and acute stress disorders were not included. In the DSM-5, the term “hysteria” was replaced with “somatic symptom disorder”, and Asperger’s was removed as an independent diagnosis and instead included within the Autism spectrum (Surís et al., 2016). Further advances in the medical understanding of mental health and diagnostic procedures for psychiatric disorders will likely prompt continued evolution of this manual, as well as psychiatric and psychological practices.

Even for those without a diagnosed mental illness, mental and emotional health are highly influenced by stress. Each year the American Psychological Association (APA) conducts a survey on Stress in America to get a snapshot of the amount of stress Americans are experiencing and the most common stressors (sources of stress). The data for 2023 indicate increased stress in America due to recovery from the COVID-19 pandemic, as well as global conflict, inflation, racism and racial injustice, and climate disasters (such as drought, wildfires, floods, and severe storms). Collective traumatic stress from the pandemic may be impacting the psychological and physical health of individuals and communities in the U.S., where COVID-19 has claimed the lives of over 1 million people, caused huge job losses and economic impacts, and strained social cohesion. According to this latest analysis, self-reported mental illness diagnoses have increased from 32% of adults in 2019 to 37% of adults in 2023 (though 81% of those surveyed reported their own mental health as good or better). Those reporting a stress level of 8/10 or higher rose from 19% in 2019 to 24% in 2023. The increase was especially pronounced for those aged 35-44 (American Psychological Association, 2023).

Mental health issues are particularly concerning for adolescents. Over half of all mental illness cases will start showing symptoms by age 14, and 75% of them develop symptoms before 24 ((CDC/National Center for Injury Prevention and Control, 2024). The top 3 leading causes of death for adolescents are unintentional injuries (accidents), homicides, and suicides (Elflein, 2024), all of which may have poor mental health as a factor. Young people with poor mental health are also more likely to engage in risky behaviors such as unprotected sex and drug use. The Youth Risk Behavior Surveillance Survey in 2021 reported that persistent feelings of sadness and hopelessness (symptoms of depression) affected 42% of high school students, and this rate was significantly higher for female students and LGBTQ+ youth. Overall, rates of poor mental health for high schoolers had increased since 2011 (CDC/DASH, 2023).

College students are also struggling with increasing rates of mental health issues, particularly during the recovery from the COVID-19 pandemic. According to one study, in 2020-2021, over 60% of college students met the criteria for a mental health disorder - a 50% increase from 2013 (Lipson et al., 2022). High levels of stress are often reported by college students, as well as depression, anxiety, panic attacks, and substance abuse problems. In fact, college may be where many students first begin experiencing symptoms of mental disorders, and/or begin using stimulants or prescription substances to get high or help with studying. Having a supportive network of family and friends as well as access to mental health services on campus may help to help students find balance and prevent them from dropping out early. Common barriers to getting help include social stigma of seeking help for mental health, as well as cost and access to counselors (Johnson et al., 2023).