Approximately 20% of adults in the United States and Canada have a mental illness. This proportion is even higher for adolescents (13-18 years old) — at 50%. Among adults, mental illness affects more women than men and more young adults (18-25 years old) than older adults (50 years and older). In the United States, anxiety disorders and depression are the two most common diagnoses.
Despite the great burden caused by mental ill health, effective treatment options do not exist for everyone, and healthcare-seeking at mental health services remains suboptimal, used by only 47% of adults with a mental illness in the United States. This could be due to many reasons, including a lack of access to services, persistent stigma associated with mental illness, and lack of treatment efficacy. Additional research is still needed to identify the multifactorial factors underlying each condition, determine how that information can be leveraged to best develop effective treatments, and characterize why some people seek much-needed treatment while other individuals do not.
Here, we review three mental illnesses with clinical trials being conducted at Headlands Research sites, namely depression, social anxiety, and schizophrenia.
Depression
Based on nationally collected data from individuals 12 years and older in both countries, 9.2% in the United States and 6.7% in Canada had depression in 2020. Young adults (18-25 years old) and adolescents (12-17 years old) are the most affected and experienced the most rapid increase in depression rates over the surveys’ time periods. In the United States, the prevalence of help-seeking remained consistently low over the entire study period (at ~40%). Although both men and women experienced increased prevalences of depression from 2015 to 2020, women consistently had higher rates of depression over the entire study period: 11.8% in 2020 for women and 6.4% for men.
Regarding race/ethnicity, in the United States, non-Hispanic White individuals had the highest prevalence in 2020, at 10.1%, compared with 6.9% for non-Hispanic Black individuals and 7.9% for Hispanic individuals. Those with the lowest household income were the most affected (<$20,000; 11.6%), while those with the highest household income were the least affected (≥$75,000; 7.5%).
It’s worrying that only approximately one-half (51.7%) of all the individuals with depression had consulted their doctor or other healthcare professional, and even fewer (38.7%) had received prescription medication for their symptoms. These healthcare-seeking behaviors have not changed over the years.
An increase in undiagnosed, untreated, and symptoms of depression during the COVID-19 pandemic has been a hot topic, given the additional stress of a potentially life-threatening infectious disease, social isolation during stay-at-home orders, limited access to healthcare services, and disruptions to income, careers, and school. Several studies have documented these changes, including one using nationally collected data early in the pandemic (April 15-20, 2020) in the United States and another using nationally collected data in Canada (2020). In both countries, the prevalence of depressive symptoms was more than 2-3 times higher during the COVID-19 period than during the pre-COVID study period.
In a nationally representative survey conducted with a racially/ethnically diverse US adult population during COVID-19 (December 2020 to February 2021), 23.7% of the study sample reported moderate/severe anxiety-depression symptoms, which affected White adults significantly more than all other racial/ethnic groups. A systematic review of 12 studies conducted from March 2020 to June 2021 reported the following average prevalences of poor mental health across studies: 12.9% for severe depression, 26.0% for at least moderate depression, and 36.0% for at least mild depression. These rates are much higher than the pre-COVID-19 prevalence estimates.
A combination of therapy and medications is typically used to manage depression, although the heterogeneity of presentation and underlying factors often requires personalization of the treatment regimen. As depression continues to be a high-burden condition across the population, additional treatment options and pathways to accessing care are under investigation, with the hope of finding effective solutions for everyone.
“Depression remains difficult to treat for more than two-thirds of people on antidepressant medications. Although there are several good antidepressant medication options available, we know from large, long-term studies that too few people respond to them. At Artemis, we are studying several antidepressant medications that approach the neurochemistry of depression in very different ways than what is currently available — enabling us to focus on providing care for people with treatment-resistant depression.”
- Eric Chavez, MD, MSc
Principal Investigator and Associate Medical Director at Artemis Institute, a Headlands Research site
Social anxiety disorder
Compared with the 923 studies currently active for depression on clinicaltrials.gov, only 57 studies are listed for social anxiety disorder (SAD). This remains an unmet need for the estimated 7% of the US adult and Canadian adult population affected by the disorder, with studies showing that far less research has been conducted over the last decade for novel treatments for anxiety disorders than for major depressive disorder or schizophrenia.
Equally common among men and women, SAD typically begins around the age of 13 years and, according to the National Institute of Mental Health, involves an “intense, persistent fear of being watched and judged by others, … a fear that can affect work, school, and other daily activities. It can even make it hard to make and keep friends.” To help cope, people with SAD, particularly severe SAD, are more likely to turn to harmful cannabis and/or alcohol use.
Similar to the treatment for depression, treatment for SAD includes a combination of therapy and medication, which can vary in efficacy from person to person and over time. With the potential to profoundly impact quality of life across a person’s lifespan, new effective treatments are urgently needed.
Schizophrenia
Recent, significant advances in our understanding of the neurobiology of schizophrenia are helping inform drug development and address the limited treatment options. Currently in the top 15 leading causes of disability worldwide, schizophrenia contributes to an average 14.5 years of life lost globally and results in mortality rates in the United States that are 3.5 times higher than in the general population. The condition typically manifests as delusions, hallucinations, psychotic episodes, and unusual physical behavior, profoundly disrupting the affected person’s life.
Exact prevalences are challenging to determine owing to the complexity of diagnosis, differing diagnostic methods, and overlap with other mental illnesses. However, in the United States, it’s estimated to affect between 0.25% and 0.64% of the adult population, while in Canada, approximately 1% of adults are affected. An often persistent, severe, and disabling mental condition, the costs related to schizophrenia are disproportionately high compared with other chronic conditions — with both direct costs of healthcare and indirect costs of lost productivity, social service needs, criminal justice costs, and other non-healthcare costs contributing.
Therapy is lifelong and typically consists of a combination of medication, therapy, and social support, which can effectively manage the symptoms and allow people with schizophrenia to pursue the life they want to lead. However, gaps still persist in pharmaceutical treatment options, particularly as we learn more about the genetic causes and changes in brain chemistry that underlie the disease processes.
Experienced, qualified researchers are key to improving mental illness outcomes.
Mental illnesses can be nuanced, both to study and treat. Having experienced, qualified researchers involved in studies for conditions such as depression, SAD, and schizophrenia is important for both study and participant outcomes. At Headlands Research, our sites such as Artemis Institute for Clinical Research, Okanagan Clinical Trials, and Summit Research have specialists in psychiatry/psychology and dedicated psychometricians to lead and execute clinical trials for mental illnesses.
Contact us to discuss how our sites can support your future mental health studies.