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Beware of “killer statistics” in the mental health field

Melissa Raven writes:

Some statistics are very powerful, because they convey a shocking message that demands attention. They are often referred to as ‘killer statistics’.

Here is one, and in fact it is doubly a killer statistic: ‘Depression will be the second largest killer after heart disease by 2020’.

It is on the ‘Depression Facts and Stats’  webpage of Dr Bob Murray and Alicia Fortinberry’s Uplift Program.

It is also on an increasing number of other webpages – thousands of them.

And unfortunately it is wildly inaccurate, as killer statistics often are.

The reference cited by Murray & Fortinberry is ‘WHO report on mental illness released October 4, 2001’. Clearly what this refers to is the WHO’s ‘World Health Report 2001 – Mental Health: New Understanding, New Hope’.

But according to that report, depression will be the second largest cause of burden of disease (disability-adjusted life years [DALYs]), not mortality, by 2020:

By the year 2020, if current trends for demographic and epidemiological transition continue, the burden of depression will increase to 5.7% of the total burden of disease, becoming the second leading cause of DALYs lost. Worldwide it will be second only to ischaemic heart disease for DALYs lost for both sexes. (p. 30)

According to the WHO/World Bank Global Burden of Disease study (Murray & Lopez 1996), the 10 leading causes of death worldwide in 2020 will be:

1. ischaemic heart disease

2. cerebrovascular disease

3. chronic obstructive pulmonary disease

4. lower respiratory infections

5. trachea/bronchus/lung cancers

6. road traffic accidents

7. tuberculosis

8. stomach cancer

9. HIV

10. self-inflicted injuries

(Table 7.4, p. 362. Murray & Lopez actually presented three different projections, based on different scenarios, but the top 10 causes of death are similar in all three. Conveniently, Murray & Lopez’s table has been reproduced in Flint et al.’s (2007) ‘Trauma: Contemporary Principles and Therapy’ (p. 27, Table 8).)

Some fatal self-inflicted injuries would be partly attributable to depression, but by no means all. So depression will be nowhere near the second leading killer in 2020. Most people with depression do not die particularly young, so most of the burden of disease comes from years lived with disability, not from premature mortality.

I contacted Murray and Fortinberry about this problem weeks ago, and I was told on 15 February that the webpage was being changed ‘now’.

But the killer statistic is still there, as are other misleading claims. And even if it is eventually removed from the webpage, I predict that it will still be doing the rounds in 2020. Once these killer statistics are launched, they tend to have considerable longevity.

Another inaccurate statistic cropped up very publicly last year in Shadow Minister for Health & Ageing Peter Dutton’s mental health motion, which was passed in the House of Representatives in November.

It was also in Senator Concetta Fierravanti-Wells’ similarly worded motion in the Senate, and in Shadow Parliamentary Secretary for Primary Healthcare Andrew Southcott’s speech to Peter Dutton’s motion.

It is not about causes of death, but it is also a killer statistic: ‘mental illness afflicts more Australians than almost all other health disorders, only ranking behind cancer and heart disease in prevalence’.

Once again, burden of disease has been confused with something else, in this case prevalence. The reality is that mental illness ranks third (2003) or fourth (2013 projection) behind cancer and cardiovascular disease in terms of burden of disease (Begg et al. 2007, p. 125), not prevalence.

Now that this inaccurate statistic is enshrined in Hansard, it is sure to crop up repeatedly in the ongoing mental health debate, and few people will question it.

As Associate Professr Jon Jureidini and I pointed out last year, misleading killer statistics are all too common in the mental health field, as is resistance to retracting them. And they are usually taken at face value, particularly when uttered by experts.

Next time you read or hear a startling statistic about depression, or suicide, or mental illness, or mental health services, you would do well to stop and think, ‘Hang on, is this actually accurate?’.

• Melissa Raven is a psychiatric epidemiologist and policy analyst, Adjunct Lecturer, Discipline of Public Health, Flinders University and a member, of Healthy Skepticism.

Comments 4

  1. Shooba says:

    “15% of depressed people will commit suicide.” – The Uplift website

    I call BS. I wish a regulatory body somewhere could ban mental health’s zillion experts from stating something as fact when it is based in vague descriptions of symptoms, half-truths and dubious surveys.

  2. carolinestorm@iinet.net.au says:

    The problem comes from the fact that we desperately need new definitions for mental illness. When Professor Pat McGorry, as he did a few weeks ago, speaks of 4.4 million mentally ill in Australia he is shadowing what is already a very unclear picture and actually causing problems for the seriously mentally ill, whom he most wants to help. Politicians who hear that number will sigh with sympathy and turn their eyes to other, less impossible causes.
    The WHO states that 2.5-3% of people globally have a serious mental illness. This number denotes people with the incurable brain diseases of schizophrenia, bipolar 1 and some severe affective disorders.
    It should be possible, if the RANZCP ever emerges from its torpor of the last 20 twenty years (excepting that small group who try to tell it as it is, of course), for new ways of defining mental ill health to emerge. Mental illness is not quantifiable, but almost all sufferers may be defined in the way used by the WHO: the 2.5 % very seriously mentally ill with esentially incurable, though certainly treatable, mental disease; the remaining 97.5% of people, many of whom suffer from the transient to long-lasting, mild to severe, treatable and curable mental disorders.
    This difference needs to be emphasised and made public, so that we become educated enough to distinguish between the main types of mental ill health. It’s a given that there will always be some cases impossible to define. But it must become clear that, in Australia, we have some 550,000 people who are severely mentally ill and should receive the most funding and care, according to their burden of disease, as do the severely ill of all other health services. We also have very large group of the remaining population, it is suggested 1 in 5, who have less serious problems but should receive treatment as needed.
    We must define these groups: the seriously mentally ill have a ‘complex mental illness’, the remaining and far larger group have a ‘simple mental illness’. Better but like names, giving us the same important information, must become part of our understanding and speech when discussing mental health.

  3. Ultimo167 says:

    Bravo! Disease mongering and making up bald-faced lies to exaggerate the existence and impact of so-called ‘mental illness’ is indeed all the rage right now, but beneath the easy critiques of big pharma and its heavy hand throughout this masquerade, lies the stark reality that those people who are indeed seriously mentally unwell continue to miss out on the services that they so desperately need to facilitate recovery. Moreover, the clinical pessimism and sheer despair of bio-psychiatry in claiming that not only are we doomed but doomed in advance detracts from the preventative efforts that should be directed toward ensuring good mental health throughout the lifespan, including every citizen having access to the skills/knowledge that can assist us in said endeavour. And yes, I am wondering how much of the garbage that counts for hard psycho-pathological evidence can be churned out within the context of ‘rigorous’ research? The death drummers’ up in the suicide prevention industry (I shan’t name any names here) demand a particularly hard boot up their dates, lovers as they are of promoting death but deniers as they too of promoting life. Viva la resilience!

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
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Closing the Credibility Gap 2013
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Health Workforce Australia 2013
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2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
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2015 conferences
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Population Health Congress 2015
2016 conferences
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2017 conferences
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Australian Palliative Care Conference
2018 conferences
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