Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health

Soc Psychiatry Psychiatr Epidemiol. 2024 Mar;59(3):443-453. doi: 10.1007/s00127-023-02474-4. Epub 2023 Apr 17.

Abstract

Purpose: The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge.

Methods: Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics.

Results: Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems.

Conclusions: The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.

Keywords: Labelling theory; Mental health literacy; Social construction; Unmet need.

MeSH terms

  • Educational Status
  • Health Literacy*
  • Humans
  • Mental Health*
  • Psychopathology
  • Self Report