Is America Less Mentally Healthy Than A Chilean Jail?

By Neuroskeptic | October 12, 2013 10:01 am

The average prison inmate in Chile has better mental health than the average American citizen, according to an eyebrow raising report just published.

Researchers Adrian Mundt and colleagues ran a random survey of 1000 participants from among Chile’s 47,000 prisoners. Fieldworkers went into the prisons and aimed to determine rates of DSM-IV diagnoses. They found that the 12 month prevalence of any mental disorder in the Chilean prisoners was 26.6%.

One in four. That sounds high. But in psychiatric epidemiology, high is relative.

A 12-month prevalence 26.6% is higher than the most recent comparable data from the Chilean general population, slightly (22.2%)

But 26.6% is quite a bit lower than the 12-month figure for the general population of the USA – 32.4% according to the National Comorbidity Survey Replication (NCS-R) study, which used the same CIDI instrument and assessed the same set of diagnoses.

So, taken at face value these data are a sad reflection on the nature of American society, but should we take them in that way?

Probably not. I’ve written extensively on the problematic nature of mental health surveys like this. For example, I once showed that across different countries, rates of estimated 12-month mental illness don’t correlate with national suicide rates (an observation later published in a peer reviewed article…by someone else.)

This casts doubt on how meaningful they are as a measure of psychiatric disorder if we make the reasonable assumption that all other things being equal, more mental illness means more suicide.

I wrote that the surveys might be biased by cultural factors:

The surveys do seem to measure something, but I don’t think it has much to do with mental illness. This is just a guess but I suspect they’re measuring willingness to talk about your emotional life to strangers. At least stereotypically, the Chinese and the Japanese [very low reported rates of mental illness] are known as more reserved in this regard than Brazilians and Americans [very high rates].

So it’s no surprise that when you ask people a load of personal questions, the “rates of mental illness” seem to be lower in Japan than in America. This doesn’t mean Americans are really more ill, just more open.

I do not know much about the culture of Chilean prisoners, but I’d imagine that they’re not enormously fond of disclosing their feelings to strangers. Or, maybe, they have a different set of standards for what constitute feelings that are out of the ordinary and worth reporting (a different personal yardstick of normality).

So the ’27%’ for Chilean prisoners might not be a point on the same psychological scale as the ’32%’ from US citizens.

This is all speculation, of course. But the authors of this paper don’t even speculate about it. They compare their results to results from prisons in other countries, but they don’t consider general populations. They discuss why Chile’s prisons are different to Iran’s, but when it comes to the whole of US society, they don’t seem to find the comparison interesting.

ResearchBlogging.orgMundt AP, Alvarado R, Fritsch R, Poblete C, Villagra C, Kastner S, & Priebe S (2013). Prevalence rates of mental disorders in Chilean prisons. PLoS ONE, 8 (7) PMID: 23894415

  • http://bebrainfit.com/ Deane Alban

    You’ve shown that we are slightly more mentally healthy than Chilean prisoners but the US citizenry should not be in the running. Sad commentary on the state of our brains.

  • MentalIllnessPolicy

    Can you explain this “if we make the reasonable assumption that all other things being equal, more mental illness means more suicide.” tx.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      Sure. We know that people with mental illness are (very) overrepresented among suicides. In depression the risk is especially high, but it is strongly raised across disorders.

      So all other things being equal, if you triple (say) the rates of mental illness, you’d roughly triple the rates of suicide.

      By “all other things” I mean cultural or social factors that affect the suicide rate independent of the levels of mental illness, e.g. easy availability of methods (guns & poisons).

      • MentalIllnessPolicy

        Tx. Now I get it. I was looking at it the other way. Even if suicide is disproportionately associated with mental illness, mental illness (as you are suggesting) mental illness is small part of population (depending on how defined). Yet figures are bandied about that 90% of suicide is due to mental illness. I’ve seen the ‘evidence’ but the ‘evidence’ doesn’t pass “smell test’ with me. It just “seems” (my own scientific word) like more than 10% of suicides are related to non-mental illness issues. Thoughts? tx.

        • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

          There is lots of evidence that most suicides had a mental illness when they died, as you say.

          But as you say, it often seems that mental illness wasn’t the only thing going on in their lives at that time.

          Maybe it’s like this? – although suicide is often triggered by a stressful life event, and seems to be a “response to something”, most of the people who experience similar events do not suicide. It’s mental illness that makes them vulnerable.

  • Pingback: Is America Less Mentally Healthy Than A Chilean Jail? – Neuroskeptic | DiscoverMagazine.com | Kenneth Lipp

  • Ezequiel

    US citizens, when are you going to learn? America is a continent, not a country, and Chile is part of that continent.

    • Buddy199

      Thanks, professor.

      • Piq Maq

        Yes

      • Piq Maq

        And “Latin” came from the Ancient Roman culture.

    • JonFrum

      Canadians don’t call themselves Americans. Mexicans don’t consider themselves Americans. Nor do Brazilians, Panamanians or Colombians. “The Americas” is a geographical term. “American” is a nationality. Is this distinction too difficult for you?

      • Ezequiel

        did you even read the title? it doesn’t say “americans”, it says “america”, just because you’re less mentally healthy than chilean prisoners doesn’t mean we all are. I always hear stuff like “people in america are so dumb, they don’t know anything, they can’t even find their country in a map” and it makes me angry because I also live in America, but just because I don’t live in USA I’m not an american I’m a “latino” (because that is how it works better for you, there is americans and the rest are latinos) and then I hear stuff like “but you don’t look like a latino”, and thats funny

    • Ken

      American:1570s (n.); 1590s (adj.), from Modern Latin Americanus, from America (q.v.); originally in reference to what now are called Native Americans; the sense of “resident of North America of European (originally British) descent” is first recorded 1640s (adj.); 1765 (n.).

      • Piq Maq

        What is the point

  • http://blogs.discovermagazine.com Mark Enriquez

    is it really “mental illness” that causes someone to kill themselves when, in most cases, the individual is ending their life because they have lost hope that they will ever be accepted by society and are simply tired of the struggle and of being left behind?

    depression cannot automatically mean “mental illness”…normal people go thru deep depressive states all the time…

    • KY HARIMA

      Personally, I think extremely unhealthy mental state can be read as a kind of metal illness

  • Pingback: Is America Less Mentally Healthy Than A Chilean Jail? - Neuroskeptic | DiscoverMagazine.com

  • Buddy199

    “I do not know much about the culture of Chilean prisoners, but I’d imagine that they’re not enormously fond of disclosing their feelings to strangers. Or, maybe, they have a different set of standards for what constitute feelings that are out of the ordinary and worth reporting (a different personal yardstick of normality).”
    ————
    You hit it on the head. Although this study makes for an irresistible headline in the Huffington Post and other mass media, there’s an incredible amount of inter-cultural “static” blurring the data.

  • Lara

    I find your “resistance ” to these type of comparison reliable if we are comparing two very different cultures (for n amount of reasons) like Japanese or Iranian. Now, I believe that many (I don’t know the details for every single one) of the countries in our continent have a somehow similar cultural/religious background -in general- specially since we have around the same chronological/historical age as independent countries.
    I was born in Chile though I migrated here several years ago: besides “size” and economic distribution we are not very different.

  • Brian Allan Cobb

    Absent corrupt guards and/or violent fellow inmates, jail’s a pretty stable environment.
    Would be interested in a survey of American prisoners.

  • JonFrum

    As they say in the sciences, ‘There is no ‘science’ in Social Science.

  • MyKitchenandI

    The other variable seemingly not considered is whether their prison system is fairly incarcerating folks. If a lot of the people were more political prisoners, in jail bc someone didn’t like them and the system is corrupt, I wouldn’t expect to see as much mental illness among their prison population as you’d see in a country where people are legitimately incarcerated for poor behavior.

  • Pingback: 2013-10-18 Spike activity « Mind Hacks

  • Pingback: ¿Es la salud mental americana peor que la de una cárcel de Chile? [ING] | Grace To You

  • Piq Maq

    US constitution let the people got guns as basic citizen equipment, so there is your mental illness

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Neuroskeptic

No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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