Prentice Tom, Md: The Clinical Importance of Detection

Millions of Americans suffer the debilitating effects of mental disorders each year. May is Mental Health Awareness Month and provides an opportunity for all of us to spread the word, raise awareness, and support those who experience mental health challenges. Today, we want to shed light on the importance of clinical detection of mental health illnesses.

We all know the importance of clinical detection when it comes to physical diseases.  The sooner you catch something, the greater the chances are for survival.  Catching rapidly growing cancer cells before it reaches a certain stage can dramatically change a patient’s outcome.  Early detection of diabetes can empower patients to proactively alter habits and reverse the disease altogether.  But what about mental health disorders?  I had a chance to sit down with Prentice Tom, MD., Chief Medical Officer at Kintsugi to discuss the clinical importance of detection of mental health disorders and his take on why they are so overlooked. 

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In your experience, what is the clinical importance of detection for mental health diseases?  

Mental health disorders are one of the most underdiagnosed health conditions in the United States, perhaps globally, and unfortunately, the frequency of mental health disorders is on the rise.  As the population ages, chronic diseases become more common.  There is a high correlation between chronic disease and depression.  In fact, estimates of depression as a comorbidity to chronic disease run as high as 80%.  It isn’t that surprising that elderly patients with multisystem chronic diseases suffer from some degree of depression and/or anxiety. 

Undiagnosed and untreated mental health conditions result in unnecessary suffering and also place an additional burden on our already over-taxed and expensive healthcare delivery system.  There is evidence that patients with mental health disorders significantly and independently increase their use of the healthcare system.  Studies show that 50% of recurrent emergency department patients, one of the most expensive avenues of seeking medical care, have a mental health condition.  

Additionally, early detection of mental health conditions would help decrease costly and unnecessary spiraling of health care costs.  People who suffer from chronic diseases develop depression and anxiety disorders.  If left undiagnosed and untreated, these patients not only suffer needlessly but also access the healthcare system even more, putting a strain on our limited resources.  

     “There is still an unmet need for mental health treatment among youth and adults. 60% of youth with major depression did not receive any mental health treatment. Even in states with the greatest access, over 38% are not receiving the mental health services they need.”    

— Mental Health America

What would you say is the clinical importance of mental health detection for the younger generation?  

There is an epidemic of anxiety disorder among today's youth.  It seems as if almost every young person knows someone who suffers from an anxiety disorder.   It's alarming and disconcerting how the milieu of social issues and pressures facing today's youth have resulted in chronic uncertainty and stress. 

The range of issues resulting from internet access (such as the expectation of immediacy of action, anonymous meanness, and media attention to adverse events), to the pressure from a young age to compete for college slots, to the uncertain job market -- the convergence of all these factors is overwhelming for many.  As a result, anxiety disorder, especially amongst our nation’s youth, has reached epidemic proportions.  If we can improve our ability to detect budding anxiety disorders, we may be able to stem the condition early on and improve the anxiety disorder sufferer’s ability to function and more fully enjoy life.  

So what's the clinical importance of detection of mental health disorders?  1)The population is getting older and there are increasing numbers with chronic disease and depression,  and 2) Social pressures have resulted in an epidemic of anxiety disorder among today’s youth.  For these two reasons alone, developing easily accessible and scalable detection for mental health disorders is one of our most pressing health concerns and one with enormous promise and value proposition.

Does early detection usually lead to similar successful outcomes as physical diseases?  

The negative ramifications of untreated mental health disorders are immense, yet the total cost is difficult to quantify.  It is possible to measure the direct health care dollars spent on these disorders.  However, the impact on productivity, life enjoyment, and the cost to family and social networks are much more difficult to measure. 

Anxiety and depression are chronic conditions that can last for years, if not a lifetime.  Like many physical diseases, earlier diagnosis results in improved outcomes and reduced suffering.  When appropriately treated, mental health disorders can often improve even relatively more than may be expected, for many chronic physical diseases.       

Why are mental health disorders so often overlooked and left untreated?  

Mental health conditions can be hard to diagnose.  Some patients may feel there is a stigma associated with a psychiatric diagnosis and may purposely decide to not share their concerns with their care provider. 

In addition, unlike many physical conditions such as trauma or a fever, the patient may not be aware that their emotional state rises to the level of pathology.  And until Kintsugi, there were no easily measurable, reproducible, quantifiable biomarkers that could be used for the diagnosis of mental health disorders.  

Clinical diagnosis is also more provider-dependent.  Clinicians often focus on conditions they can measure, and are less attuned to mental health disorders, especially when the symptoms can be subtle and subjective.  Unlike many standards, such as an immunization schedule, age for first mammogram or colonoscopy, or regular blood pressure checks, there are no set interval criteria for mental health screening.  

     “Lost productivity as a result of two of the most common mental disorders, anxiety and depression, costs the global economy US $1 trillion each year.  In total, poor mental health is projected to rise to $6 trillion by 2030.”    

— The Lancelot Global Health

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What are the costs of mental health disorders and inversely what happens when detection is delayed? 

The effects of mental health on the costs of care for chronic illnesses are 2-3x higher than treating chronic illnesses alone.  From a productivity standpoint, we can also measure the works days missed due to mental health disorders.  But the decrease in productivity resulting from untreated or undertreated mental health conditions is much harder to determine.  It’s possible that the decrease in function is even greater than it is for many physical conditions.    

The real question is, what is the human cost?  The human cost of having people suffer unnecessarily from mental health disorders shouldn't be allowed.  It is uncalled for and avoidable.  If we delay detection we just prolong the amount of suffering.  

Mental Health Awareness Month serves as a reminder that detection is essential, now more than ever.  The Centers for Disease Control and Prevention has reported an increase in symptoms of depression and anxiety from 36.4% to 41.5% since the COVID-19 global pandemic.  The very measures intended to protect the public, and heightened political and social issues, have exacerbated feelings of despair and loneliness. 

Furthermore, the percentage of those reporting unmet mental healthcare needs has increased from 9.2% to 11.7%.  These trends in mental health show us that there will soon be an overwhelming number of people who need access to mental healthcare and that there is also a greater strategic need for the clinical detection of depression and anxiety.