Do social factors explain higher mental disorder diagnosis rate?


Most psychiatrists and mental health experts are aware that a person's environment - the things happening around them and to them - are often as influential in their mental disorders as are anything physical or genetic.

With the rising rate of mental health diagnoses among North Americans, however, questions about how much of that is environmental are being asked more often.

A recent collaboration of research between several prominent universities in the U.S. is asking not only whether environmental factors are to blame, but also whether the rise in diagnosis rates may be due to problems with the psychiatric manual itself.

The team, made up of researchers from New York University, Columbia University, the University of California at Berkeley, and Rutgers University argues that the DSM-5 - the new version of the "psychiatric bible" for diagnosis - may have missed critical population-level and social determinants of mental health disorders and their diagnoses. This would mean that the DSM is mischaracterizing the rates of some afflictions.

Why are ADHD diagnoses higher in the US?

Helena Hansen, MD, PhD at NYU and lead author of the report, says that with the rates of attention deficit hyperactivity disorder (ADHD) in the U.S. compared to Europe and even within geographic regions within the U.S., there either has to be a significant environmental factor that is primarily affecting American children and not children elsewhere or the rates of diagnosis here are overblown. In either case, it's something we need to know.

"To explore this, we assembled a group of population health experts to identify the best way to explain the rise in these diagnoses," Hansen told Medical Xpress. "And what we found was that the clinical authorities in psychiatry who revise the DSM are unable to take into account other forces that drive the diagnosis of mental disorders."

The research team posed three questions as possible causes for the rise in diagnoses not accounted for in revisions of the manual:

  1. Is there a change in the environment causing an actual increase in the mental health problem? For example, have the pressures of standardized testing in the U.S. caused ADHD symptoms?
  2. Are the diagnostic criteria applied differently depending on the institutional and social environment? For instance, do the increasing numbers of children diagnosed with ADHD reflect pharmaceutical company promotion of ADHD awareness and ADHD medications among school teachers and parents? Among low income children, do diagnoses reflect their effort to qualify for disability benefits in the wake of welfare reform?
  3. Are the diagnostic criteria written in a way that includes people who do not have a disorder? For example, do the criteria for ADHD of excessive running, climbing, and talkativeness describe a high level of energy that should be expected among children?

The research team is proposing an independent review of those factors to answer the questions raised.

ocd self test
Do you or a loved one feel like you might have a problem with OCD? Take the Self Test now to get more information.

The information provided on is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her health professional. This information is solely for informational and educational purposes. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Neither the owners or employees of nor the author(s) of site content take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading this site. Always speak with your primary health care provider before engaging in any form of self treatment. Click here to read our complete Terms of Use.

Susbscribe to our free newsletter and receive information & inspiration

Email Social