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Public opinion surveys suggest that many people think mental
illness and violence go hand in hand. A 2006 national survey found,
for example, that 60% of Americans thought that people with
schizophrenia were likely to act violently toward someone else,
while 32% thought that people with major depression were likely to
In fact, research suggests that this public perception does not
reflect reality. Most individuals with psychiatric disorders are
not violent. Although a subset of people with psychiatric disorders
commit assaults and violent crimes, findings have been inconsistent
about how much mental illness contributes to this behavior and how
much substance abuse and other factors do.
An ongoing problem in the scientific literature is that studies
have used different methods to assess rates of violence — both in
people with mental illness and in control groups used for
comparison. Some studies rely on "self-reporting," or participants'
own recollection of whether they have acted violently toward
others. Such studies may underestimate rates of violence for
several reasons. Participants may forget what they did in the past,
or may be embarrassed about or unwilling to admit to violent
behavior. Other studies have compared data from the criminal
justice system, such as arrest rates among people with mental
illness and those without. But these studies, by definition
involving a subset of people, may also misstate rates of violence
in the community. Finally, some studies have not controlled for the
multiple variables beyond substance abuse that contribute to
violent behavior (whether an individual is mentally ill or not),
such as poverty, family history, personal adversity or stress, and
The issue of painkiller addiction is receiving more attention
because prescriptions for opioids have increased tenfold since
1990. Paralleling this trend, the number of people addicted to
painkillers has also increased over time.
Columbia University researchers found that opioid addiction had
tripled over a 10-year period, with the proportion of Americans
reporting abuse or dependence increasing from 0.1% of the
population in 1991–92 to 0.3% in 2001–02. The 2009 National
Survey on Drug Use and Health found that nearly two million
Americans were dependent on or abusing prescription pain
relievers — nearly twice as great as the number of people
addicted to cocaine.
According to the latest statistics compiled by the Centers for
Disease Control and Prevention, in 2007 painkillers killed twice
as many people as cocaine and five times as many as heroin.
Opioid painkiller addiction was also more common than abuse of or
dependence on any other type of prescription drug.
While there is a well-known relationship between major depression
and cardiovascular disease, much less is known about how anxiety
disorders affect the heart. Various studies have found that 24% to
31% of patients with cardiovascular disease have symptoms of
anxiety. Moreover, severe anxiety — which may manifest as a panic
attack — can mimic a heart attack. One analysis of studies
involving people admitted to emergency rooms for chest pain found
that 22% of those who underwent cardiovascular testing had panic
disorder rather than heart disease.
Most research on anxiety and heart disease is flawed, relying on
participants' recollections or single objective "snapshot"
assessments rather than using structured interviews to diagnose
anxiety. Many studies have also lacked controls for factors such as
lifestyle that could affect heart disease risk.
Two prospective studies followed large numbers of participants over
time to better examine the relationship between heart disease and
one of the most common anxiety disorders, generalized anxiety
disorder — characterized by constant and pervasive anxiety, even
about mundane matters. A particular strength of these studies is
that they controlled for confounding factors such as major
depression (which often occurs in conjunction with anxiety) and
demographic and lifestyle factors that affect heart disease risk.
Both suggest that generalized anxiety disorder may indeed increase
risk of heart attacks and other adverse events.
Taking an omega-3 supplement during pregnancy does not
significantly reduce the likelihood of experiencing postpartum
My husband has attention deficit hyperactivity disorder. Someone
suggested that metacognitive therapy might help him become better
organized. What is that?