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

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.