The way we approach Mental Health today is broken beyond repair. The question is, what comes next, and how fast can we get there?

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The hid­den links between men­tal dis­or­ders (Nature):

In 2018, psy­chi­a­trist Oleguer Plana-Ripoll was wrestling with a puz­zling fact about men­tal dis­or­ders. He knew that many indi­vid­u­als have mul­ti­ple con­di­tions — anx­i­ety and depres­sion, say, or schiz­o­phre­nia and bipo­lar dis­or­der. He want­ed to know how com­mon it was to have more than one diag­no­sis, so he got his hands on a data­base con­tain­ing the med­ical details of around 5.9 mil­lion Dan­ish citizens.

He was tak­en aback by what he found. Every sin­gle men­tal dis­or­der pre­dis­posed the patient to every oth­er men­tal dis­or­der — no mat­ter how dis­tinct the symp­toms. “We knew that comor­bid­i­ty was impor­tant, but we didn’t expect to find asso­ci­a­tions for all pairs,” says Plana-Ripoll, who is based at Aarhus Uni­ver­si­ty in Denmark.

The study tack­les a fun­da­men­tal ques­tion that has both­ered researchers for more than a cen­tu­ry. What are the roots of men­tal ill­ness? … The idea that men­tal ill­ness can be clas­si­fied into dis­tinct, dis­crete cat­e­gories such as ‘anx­i­ety’ or ‘psy­chosis’ has been dis­proved to a large extent. Instead, dis­or­ders shade into each oth­er, and there are no hard divid­ing lines — as Plana-Ripoll’s study so clear­ly demonstrated…

As a result, the world’s largest fun­der of men­tal-health sci­ence, the US Nation­al Insti­tute of Men­tal Health, changed the way it fund­ed research. Begin­ning in 2011, it began demand­ing more stud­ies of the bio­log­i­cal basis of dis­or­ders, instead of their symp­toms, under a pro­gramme called the Research Domain Cri­te­ria. There has since been an explo­sion of research into the bio­log­i­cal basis of psy­chopathol­o­gy, with stud­ies focus­ing on genet­ics and neu­roanato­my, among oth­er fields.

The Study:

Explor­ing Comor­bid­i­ty With­in Men­tal Dis­or­ders Among a Dan­ish Nation­al Pop­u­la­tion (JAMA Psy­chi­a­try). Key Points from the study:

  • Ques­tion: After an indi­vid­ual receives a diag­no­sis of a spe­cif­ic men­tal dis­or­der, does the risk of devel­op­ing oth­er men­tal dis­or­ders increase?
  • Find­ings: This pop­u­la­tion-based cohort study of 5 940 778 indi­vid­u­als, fol­lowed up for 83.9 mil­lion per­son-years, found that comor­bid­i­ty with­in men­tal dis­or­ders was per­va­sive (there was an increased risk of devel­op­ing all oth­er men­tal dis­or­ders after an index men­tal dis­or­der) and that the risk of devel­op­ing comor­bid­i­ty was most promi­nent in the first year after the onset of a men­tal dis­or­der; how­ev­er, the increased risk per­sist­ed over at least 15 years. For some dis­or­ders (eg, mood dis­or­ders) the absolute risks of devel­op­ing spe­cif­ic lat­er dis­or­ders (eg, anx­i­ety dis­or­ders) was sub­stan­tial (eg, 30%-40% over 5 years).
  • Mean­ing: If clin­i­cians and indi­vid­u­als with men­tal dis­or­ders had ready access to diagnosis‑, age‑, and sex-spe­cif­ic absolute risks of poten­tial future comor­bid­i­ty, this infor­ma­tion could per­mit more tai­lored inter­ven­tions and bet­ter edu­ca­tion about self-man­age­ment (ie, per­son­al­ized medicine).

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