CDC mission expands to disorders of the mind

The Centers for Disease Control and Prevention, long the nation's premier health agency, has started to embrace a subject it used to ignore: mental health.

The Atlanta-based CDC hasn't announced any major mental health initiatives. But as society has become more comfortable talking about depression, anxiety and bipolar disorder, the agency has gradually increased its attention to such conditions, studying ways to prevent them and assessing how they interact with major killers such as heart disease, cancer, diabetes and AIDS.

"Mental health used to be a tiny little whispered thing here. . . . We used to apologize for it," said Dr. Marc Safran, a psychiatrist who heads up the CDC's Mental Health Work Group. "Now we take pride in our mental health work. It has become more mainstreamed."

A case in point: At the American Psychiatric Association's annual meeting in Atlanta last week, Safran and other CDC researchers talked about their work in several mental health areas: suicide, the stress of living near toxic waste sites and links between depression and smoking, drinking and lack of exercise.

Safran was the agency's first fully trained psychiatrist in 1993 when he overheard a conversation that led to one of its first mental health efforts. A caller to the CDC's National AIDS Hotline seemed to respond crassly to a worker's instructions on condom use, so the worker ended the conversation.

Safran said the caller probably had a psychiatric disorder. A subsequent study found that 11 percent of hotline calls related to mental health. The hotline workers were trained to listen for signs of mental distress, respond to them and refer callers for counseling when appropriate.

As its mental health efforts expand, the CDC is being careful, officials say, not to tread on the turf of the two federal agencies charged with addressing mental health: the Substance Abuse and Mental Health Services Administration, which oversees mental health programs, and the National Institute of Mental Health, which researches biological causes of, and treatments for, mental disorders.

But as studies document connections between mental and physical health --- people with untreated depression are more likely to die from heart attacks, for example --- it has become vital for the CDC to include mental health in its considerations, said Dr. Julie Gerberding, CDC director. The Sept. 11, 2001, terrorist attacks also helped bring mental health issues to the forefront, she said.

"Wherever you look, whether you're talking about violence, injury or poor health habits, mental health is very prominent," Gerberding said. "We're not going to be successful in helping Americans feel more satisfied about their health if we don't address mental health." From malaria to suicide

The move is part of an evolving expansion of the CDC's mission since it was founded in 1946. Formed from a World War II unit that fought malaria, the CDC's initial charge was controlling infectious diseases. It focused first on polio, flu and smallpox and later worked on such diseases as Legionnaire's, AIDS and West Nile virus.

By the 1980s, the CDC also was tackling chronic diseases, environmental health and injuries, from falls to domestic violence and suicide. In 1992, the agency added "Prevention" to its name, indicating a desire to hinder disease, not just measure and respond to it.

Mental health largely remained a whisper at the CDC, Safran said, until 1999. That was when then-U.S. Surgeon General David Satcher, previously CDC director, issued a report saying that the annual rate of mental illness in Americans is one in five and that it accounts for 15 percent of death and disability in the United States, slightly more than cancer and second only to heart disease. A wealth of research

In 2000, the agency helped sponsor its first conference on mental health, with international experts convening at the Carter Center in Atlanta and touring CDC headquarters. The same year, Safran launched the Mental Health Work Group, now composed of nearly 100 CDC researchers.

CDC work on mental health has become routine: > A study last year found that Americans who often feel sad or depressed are more likely to smoke, binge-drink and be physically inactive, increasing their risk for many diseases. > A study this year said medical expenses from mental illnesses are significantly higher among people who don't exercise. > A survey in 2000 of Albanians in Kosovo revealed that 25 percent had symptoms of post-traumatic stress. > When CDC workers helped respond to the tsunamis in Asia last year, a "resilience team" assessed mental health needs.

At the APA meeting last week, Dr. Pamela Tucker, a CDC psychiatrist, explained how she recently helped set up mental health support groups for residents of Libby, Mont., after asbestos was found in the vermiculite mined there.

Dr. Dan Chapman, another CDC psychiatrist, said there were more than 110,000 U.S. hospital admissions of people age 65 or older through emergency room visits in 2000 due to psychiatric disorders.

Dr. Alex Crosby, with the CDC's injury prevention center, told the APA audience that many of the 30,000 suicides in the United States each year relate to mental illness. "If our mission is to prevent deaths," he said, "here's a population for which we need to be paying attention to what's going on."

Other research presented at the APA, by scientists not at the CDC, reinforced the impact of mental health on overall health.

Dr. Alexander Glassman of Columbia University said a study found that using drugs to treat depression in heart attack patients greatly reduces their risk of death.

And depression can help cause cancer or result from inflammation stemming from cancer, reported Dr. Andrew Miller, director of psychiatric oncology at Emory University's Winship Cancer Institute. For patients receiving cancer treatments that exacerbate inflammation, use of anti-depressant drugs can help, he said.

Safran, who has spearheaded the CDC's mental health efforts, said that when he arrived 12 years ago, many of his colleagues wondered why he was there. Now they ask how they can include mental health in addressing almost every health issue. "I don't hear people apologizing for it anymore."

Copyright 2005 The Atlanta Journal-Constitution