A Finnish study published in BMJ found key differences in the conceptions of psychiatric diseases among the general public, physicians, nurses, and legislators. Although most groups concurred that certain states were diseases, particularly schizophrenia and autism, other conditions were less agreed on, including substance use disorders and social anxiety disorder.
Kari Tikkinen, MD, PhD, from the University of Helsinki in Finland, and colleagues sought to address controversy surrounding definitions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The researchers wrote, “Contemporary epidemiological research suggests that as many as 25% of the population may qualify for a psychiatric diagnosis in a given year and 50% in a lifetime. These trends have prompted concern about medicalisation.”
The study, which included among its authors Allan Frances, MD, from Duke University in Durham, North Carolina, and the former chair of the DSM-IV Task Force, assessed whether certain demographics rated 20 mental health-related states of being as diseases based on a 5-point Likert scale. The population-based survey approached 6200 people and gathered 3259 eligible responses from participants categorized into 5 groups: psychiatrists, nonpsychiatrist physicians, nurses, members of parliament, and laypeople. Statistical analyses involved multivariable linear regressions.
The study sample comprised 70 psychiatrists, 668 other physicians, 965 nurses, 55 parliamentarians, and 1501 laypeople. Of all respondents, ≥75% considered schizophrenia and autism to be diseases, and >50% perceived anorexia, attention-deficit/hyperactivity disorder, bulimia, depression, generalized anxiety disorder, panic disorder, and personality disorder as diseases.
In addition, 2 states, homosexuality and grief, were not viewed as diseases by ≥75% of all respondents, and a majority (>50%) did not consider absence of sexual desire, premature ejaculation, or transsexualism to be diseases. For 6 states, including alcoholism, drug or gambling addiction, insomnia, social anxiety disorder, and work exhaustion, responses were widely divergent.
Psychiatrists had the highest mean disease perception composite score (73.5±11.2 points), followed by other physicians (68.8±10.9), nurses (67.2±11.4), legislators (64.5±10.2), and the general public (63.0±12.9). Furthermore, demographic group was significantly related to disease perception composite score in the multivariate linear regression. Younger respondents and women were more likely to rate states as diseases.
The study was limited by its focus on the Finnish population, suggesting that the findings may not be generalizable to less affluent and non-Western countries.
The researchers cautioned that although the perception of states of being as diseases may raise “public awareness of mental illness,” this shift could also escalate “the [minimization] of social and cultural explanations for human suffering” and provision of “pharmacological interventions.” They further stated that their findings “highlight the desirability of a more inclusive conversation regarding what states of being should be considered diseases.”
Tikkinen KAO, Rutanen J, Frances A, et al. Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey. BMJ Open. 2019;9:e024265.