A research team led by Professor Andrew Tai-Ann Cheng, a Distinguished Research Fellow at the Institute of the Biomedical Sciences has found that the prevalence of common mental disorders (CMDs) in Taiwan has doubled over the last twenty years (1990 to 2010), paralleling increases in national rates of unemployment, divorce, and suicide. The research was published online in the world’s leading general medical journal, The Lancet, on November 12, 2012.

        CMDs are a broad diagnostic category of non-psychotic depressive and anxiety disorders which account for over 90% of all mental disorders. The World Health Organization (WHO) Global Burden of Diseases and Injury analysis of the effects of diseases, injuries and risk factors on population health has estimated that by 2020, depression will rank second only to coronary heart disease.

　　In the Taiwan study, researchers analyzed data from 9,079 respondents and found that the prevalence of (CMDs) doubled from 11.5% in 1990 to 23.8% in 2010. The study found that increased risk factors for developing (CMDs) in Taiwan included, female sex, unemployment, being unmarried, having a lower levels of education or employment, and poor physical health. Economic instability and income inequality are also proposed to increase the risk of mental disorder.

        The trend of increasing (CMDs) remained even after controlling for all the social and physical risk factors. In addition, the increase in prevalence of CMDs paralleled rises in national rates of unemployment, divorce, and suicide (from 8.1 to 19.5 per 100 000 in men and from 5.1 to 10.9 per 100 000 in women) over the same study period.

　　The study suggests that the significant trend of increase in rates of CMDs over time may at least in part be attributable to the macrosocial changes such as the continued decline in the employment market due to relocation of the labor-intensive industries to China and Southeast Asia, and the recent global economic recession that occurred during the study period. The effect of personal risk factors for CMDs remained constant over the 20 years, the researchers found, but the increase in the unemployment rate (from 1.7% to 5.2%) brought about an increase in rates of CMDs.

　　In a commentary of the research, also published in The Lancet, Professor Martin McKee, from the Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, and Dr David Stuckler, a Cambridge sociologist, commented that “this study tells us that the Taiwan economic miracle has come at the cost of mental health among its people and the elegant work by Dr. Fu and colleagues is a timely reminder that we need something beyond the Gross National Product (GNP), such as the Genuine Progress Indicator (GPI), as a measure of national progress.”

　　Professor Andrew Tai-Ann Cheng, who led the study, comments that the research not only highlights the need to implement effective clinical and social preventive measures to promote mental health, but also the effect of uncertainty on mental health. A sense of insecurity, much like the response to job loss, can have detrimental consequences on mental wellbeing. He hopes that the government will heed the implications of the finding of the study and place more attention on the measures of “happiness” in the pursuit of economic growth.

　　With the exception of national rates of unemployment, divorce, and suicide, all the study data were retrieved from the Taiwan Social Change Survey (TSCS) database. The TSCS is currently operated by the Institute of Sociology at the Academia Sinica by national experts in social and biological sciences. The field work is conducted by the Center for Survey Research. The TSCS surveys are administered to assess changes in economic attitudes, family, globalization, national identity, political participation, social networks, and social problems since 1985. The mental health section was introduced in 1990 including a screening instrument for common mental disorders, the Chinese Health Questionnaire (CHQ), which was developed by Dr. Cheng with satisfactory validity and reliability. The research team was made up of Dr. Tiffany Szu-Ting Fu, post-doctoral fellow at the Institute of the Biomedical Sciences; Dr. Chau-Shoun Lee from the Department of Psychiatry, Taipei Mackay Memorial Hospital; Professor David Gunnell from University of Bristol, UK, and Professor Wen-Chung Lee from College of Public Health, National Taiwan University. The TSCS has been funded by the Taiwan National Science Council.

　　The full article entitled “Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey” published by The Lancet online on November 12, 2012 is available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61264-1/fulltext.

        Related websites: Lancet comment: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961602-X/fulltext