The following document is published/archived in the Libraries of the University of Virginia in original form. Minor adjustments exist herein.
Matthew Martin Mentor: Meg Bryce
The Psychotherapies of Tomorrow: The Most Common Mental Health Concerns of the Future Patient Populations of the Affluent World
Epidemics of each of the most common mental health complaints, globally, have grown over recent decades – and can be projected for the decades to come. Affluent nations, despite being some of the best places to live on Earth, are nonetheless affected by accelerating rates of mental health concerns within their populations. The needs expressed by future societies, for clinicians, will evolve alongside the psychotherapeutic treatment modalities of best practice which can successfully treat the mental health concerns of the individuals of the future.
UNIVERSITY OF VIRGINIA
The Psychotherapies of Tomorrow:
The Most Common Mental Health Concerns of the Future Patient Populations of the Affluent World
By: Matthew S. Martin
A CAPSTONE PROJECT
SUBMITTED IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE
BACHELOR OF INTERDISCIPLINARY STUDIES
MAY 2025
Dedication and Thanks
To my globally extended families and my lifelong friends, for your love and connection.
Special thanks go to Dave, Mel, Bryce, Nate, Jenna, Shelby, Jared, and Josh – who inspire me in unique ways and keep me away from the proverbial ledges in life.
Immense gratitude goes to my mentor, Professor Meg Bryce, Ph.D., for her patience, insight, inspiration, goodwill, and the perfect amounts of gravity. Never before has a mentor been able to effortlessly tether my thoughts nor so effortlessly pare down my compositions.
Each of you has ensured these efforts reach fruition.
Table of Contents
Introduction
Literature Review
Methodology
Concerning Global Surveys
Mental Health – Lost in Translation
Average Ages of Onset Across Nations
Global Rates
Depressions
Depressions Defined
Depressions in the United States
Depressions Globally
Anxiety and Fear-Related Disorders
Anxiety and Fear-Related Disorders Differentiated
Defining Anxiety and Fear-Related Disorders
Generalized Anxiety Disorder vs. Anxieties and Fears
Panic Disorder and Agoraphobia
Social Anxiety Disorder
Specific Phobia
Stress, Trauma, Substance Misuse
Projected Global Rates
Notable Psychotherapeutic Modalities
Cognitive-Behavioral Therapy
Mindfulness
Acceptance and Commitment Therapy
Play, Group, Family, and Couples Therapies
Discussion
Societal Shifts
Technological Advancement
Conclusion
References
Introduction
Individuals in the affluent world benefit from robust social, economic, infrastructural, and informational connectivity, high gross domestic products, high degrees of social stability, and high levels of education. Productivity, standards of living, and quality of life are high in these nations. Affluent nations, despite being some of the best places to live on Earth, are nonetheless affected by accelerating rates of mental health concerns within their populations. Epidemics of each of the most common mental health complaints have grown in recent decades and comprise an overarching global mental health epidemic. The epidemic is forecast to grow. The need for mental health care professionals who can successfully provide treatment for the future patient populations of affluent nations will inherently need to scale to meet the mental health care needs of patients.
Literature Review
The historic origins of the current global mental health epidemic are a valuable context. James Davies provides an investigative critique of Western psychiatry in “Cracked: Why Psychiatry Is Doing More Harm Than Good,” tracing several aspects of the epidemic’s spread over the past several decades before returning to the historical etiology of the epidemic itself (Davies, 2014). In early twentieth century Vienna, seminal psychologists like Sigmund Freud, Carl Jung, Alfred Adler, and Viktor Frankl generally viewed mental health concerns as correlated with spiritual, social, or emotional etiologies that could be treated with various competing theoretical approaches and psychotherapies. Emil Kraepelin, credited as the founder of modern psychiatry, held contrasting views which favored physical and biological etiologies of mental illnesses.
After psychology and psychiatry had blossomed and grown over the early twentieth century, new theories of mind led to the cognitive revolution in the latter half of the twentieth century. The cognitive revolution closely coincided with the advent of the semiconductor technologies which powered a fledgling Silicon Valley. When technology, science, and medicine met, there were explosive advances in fields like genetics (e.g., epigenetics, Hachimoji DNA, CRISPR), neurology (e.g., brain-computer interface, connectome mapping,), psychiatry, and pharmacology. Davies shows how psychopharmacology and psychiatry, in the contemporary world, are shadows of the original biopsychosocial views of mental illness that had, from a mass-adopted, well-rounded, and theoretical standpoint, sought to treat the biological, psychological, and social tributaries of mental illnesses for individual patients (2014). Contemporary western psychiatry favors a biological approach to the clinical diagnosis and treatment of mental illnesses, a clear echo of Emil Kraepelin’s influence.
Davies (2014) also proposes that the mental health epidemic may spread culturally due to a growing awareness of mental health and a reduction in stigma within any given culture. This growing cultural awareness is compounded by international drug conglomerates who profess chemical cures against reductionist claims of biological abnormalities. While biological components of any individual’s unique physiology will irrefutably affect mental health, psychotropic monotherapies are just one evidence-based treatment option. Medicating an individual at the level of their biology neglects the rest of the biopsychosocial model, does not address any psychological, emotional, or social components of any mental illness – and almost never offers an actual cure. Davies suggests that non-pharmacological therapies are, by default, superior as treatments.
Following the origins and spread of mental illness from the United States, the epicenter of the global mental health epidemic, Robert Whitaker’s book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America,” also connects the origins and accelerating rates of mental illnesses to drug conglomerates, the culture of Western psychiatry, and the popularization of mental health awareness among consumers (Whitaker, 2015). Whitaker charts the outcomes of patients across numerous common mental health disorders – most of whom were prescribed psychiatric drugs. He uses a measure called disability-adjusted life years (DALYs) – a metric which combines the total amount of normal or productive time that an individual might lose due to suffering from a medical impairment. Whitaker found that DALYs had increased for patients who had received long-term pharmacological monotherapies.
In fact, the trend of dispensing psychotropics without social, emotional, or psychotherapeutic supports, across different groupings of the most common mental illnesses, was found to be correlated with worsened outcomes and lower quality of life (2015). Another result of western medicines’ growing dependency upon pharmacological monotherapies was that fewer psychiatrists conducted psychotherapy. Traditional psychotherapy sessions can last an hour or more in length, whereas medication management telehealth appointments can last under ten minutes. There is a strong financial incentive in the name of providing access and treatment: if three patients can be seen within one hour (exclusively for medication management) instead of one patient per hour (for one psychotherapy session which can include medication management) over the course of a traditionally-American forty hour work week, then prescribers are able to see and bill 120 patients instead of only 40. Efficient prescribers, working overtime, could hypothetically see hundreds of medication management patients per week.
Worries of wanton overmedication or the medicalization of everyday life are valid concerns, yet these worries seem to coincide with a decrease in the stigmas that can surround mental illnesses. In psychotherapy affirming nations, mental health awareness has risen drastically over the past few decades. In what may have been a pivotal 1997 decision, the FDA approved the advertisement of psychiatric drugs on television in the United States (Gellad & Lyles, 2007). Gellad and Lyles summarize their assessment of the consequences of this regulatory shift by encouraging present-day psychiatrists to remain vigilant of how consumer demand and the potential for overdiagnoses are forces which require active countermeasures within their professional practices. Their conclusions hedge against the medicalization of everyday life while acknowledging that the demand for mental healthcare is elevated. These trends have evolved and grown into the present.
Fortunately, despite the reliance of Western psychiatry on the biological aspect of the biopsychosocial model, the proliferation of the practice of pharmacological monotherapy (e.g. without social, emotional, or psychotherapeutic elements), or the concerning potential for the medicalization of everyday life within affluent nations, counseling and therapy are viable treatment options within psychotherapy-affirming affluent cultures. Pharmacological therapies also tend to synergize with psychotherapy and, when combined with lifestyle adjustments, can create some of the best outcomes for patients. Psychotherapy is a powerful treatment option for the most common mental health concerns. Furthermore, being broad in possibilities and scope, therapy offers short-term, group, familial, and couples’ therapies in addition to in-depth individual therapies. Psychotherapeutic supports are an essential tributary to the practice of early interventions which can address the prodromal symptoms of individuals who might be at risk of developing mental health disorders later in life. Similar efforts can contribute to harm reduction, supporting individuals in high-risk demographics and those living within challenging life scenarios, can treat the consequences of substance abuse, and can improve the complex relationships of larger social groups. The social, psychological, emotional, and moral support required by default of the human condition can be met with therapy as a primary treatment or as a fortifying presence for any mental health concern.
Methodology
The primary objective of this capstone is to estimate and describe the most common clinical mental health complaints of near-future patient populations of the wealthier nations in which modern psychology is embraced as clinical field. The research question, “Which evidence-based psychotherapeutic treatment modalities will be the most in-demand therapies in the treatment of the most-common mental health complaints of the future patient populations of affluent, psychotherapy-affirming cultures over the coming decades?” requires both quantitative and qualitative approaches. Many global-class surveys, studies, and meta-analyses have been conducted regarding the incidences of mental health complaints and will provide a foundation for projections and assessments of the average compositions of future patient populations. An initial quantitative approach will involve primary sources of global class surveys and secondary sources which interpret and extrapolate their results. An intrinsically parallel qualitative approach will draw from numerous spheres of adjacent professional interest to address essential aspects of the global mental health epidemics, describe the most common mental health diagnoses and their treatments, and identify recurrent themes. Qualitative secondary sources will include studies, meta-studies, analyses, meta-analyses, scholarly articles, peer-reviewed books, and professional publications. Due to complex dynamically interrelated variables inherently introduced via cultural and futurological elements, cultural, diagnostic, technologic, and ethical concerns will be considered before cogent conclusions. The following sub-questions provide a framework for inquest:
What are the historical, contemporary, and projected incidences of the most common mental health complaints?
Which mental health complaints are most likely to be diagnosed over the next two decades?
Which psychotherapeutic treatment modalities are currently most in-demand as best practices?
Which clinical skillsets are most likely to become most prominent in the coming decades?
Concerning Global Surveys
Acknowledging the incidence of mental health concerns within any nation or culture, estimating the number of individuals who suffer from mental health complaints, is fraught with challenges at the global scale. These figures often fail to portray mental health concerns as something that impacts every individual affected. In some cultures, data concerning the incidence of any given mental health complaint is collected solely within medical settings like hospitals. (Baxter et al., 2013). In others, these nameless data points of individuals can instead be collected in clinics – in lieu of hospitals or formal medical settings entirely. Mental health information can sometimes be collected by non-clinical professionals who are not equipped to triage or diagnose. While information derived from medical and professional sources may seem viable, valid, and clear, access and subjectivity can also confound global assessments of the total numbers of human beings whose lives are impacted.
Much of the world employs the ICD-10, followed by the ICD-11, to source their diagnostic criteria and guidelines. The ICD-11, released in 2019, had been adopted by 35 nations worldwide as of 2022 (ICD-11 2022 Release, 2022). By May of 2024, the World Health Organization reported that 132 nations were in various states of adopting the ICD-11 and 14 nations were reporting their data using the standardized systems of medical codes found therein (International Classification of Diseases (ICD), 2024). The ICD-10 and ICD-11 exist in standardized international versions, yet these standardized versions are often altered by individual nations to suit their own purposes. The variances created by a localization or de-standardization process naturally can create incongruencies in diagnostics, treatment, and data collection between nations. The DSM-VI and DSM-V also serve as mental health diagnostic resources, though their adoptions and uses are somewhat unique to clinical implementations and uses in the United States. All such diagnostic manuals contain guidelines and criteria for diagnosing mental health concerns; diagnosing any patient is a task that is left to the good judgement of qualified clinicians.
Diagnosing professionals are, however, naturally and indelibly influenced by the diagnostic cultures in which their training and practice occurs. Within a single medical practice, one professional might skew towards underdiagnosis, while a clinical colleague across the hall could suffer from a tendency to pathologize everyday life and the human condition. A diagnosing professional might have advanced credentials, decades of experience, and a pristinely accurate clinical record, yet still possess cultural biases, implicit biases, or irrational stigmas that severely impact his/her diagnostic process. When considering that qualifying a patient’s symptoms or complaints via diagnostic criteria is often a matter of opinion, the subjectivity of a diagnosing professional can tip the balance between a new diagnosis, and misdiagnosis, or a clean bill of mental health. Complicating matters further, patients may over-report or under-report the severity or presence of their symptoms when speaking with mental health professionals. At the level of analysis of an entire culture or country, each diagnostic inaccuracy affects the projected incidences.
The quality and validity of surveys that researchers, academics, professionals, and governments use to assess the prevalence of mental illnesses in populations is another core consideration. Surveys featuring aspects like informal self-reports, demographics targeted or canvassed by cold calls, web surveys, apps, chat bots, or AI agents which can automate any such processes, can be dismissed due to lacking the correct kinds of professional rigor. Surveys designed and conducted with scientific and professional rigor are included in the purview of valid statistical trends.
Culture and infrastructure also play a role in assessing the state of humanity’s mental wellness. In cultures where social stigmas directly interface with access to treatments for mental health issues, individuals may be less willing to voice their mental health complaints or lack an awareness of the symptoms of mental health concerns from perspectives of Western clinicians. If an individual citizen is aware of the severity of their own symptoms and lives within a relatively stigma-free culture – one that acknowledges and supports scientific medicine, psychotherapy, and psychiatry – a lack of access to clinical care is problematic from many perspectives. Even when mental health infrastructures are present and easily accessible, a potentially substantial number of people with mental health concerns remain undocumented. Unhoused individuals, active abusers of substances, people with certain pre-existing medical conditions, and those with anti-medical worldviews are additional examples of demographics who must be respected as absent from surveys when assessing and projecting global rates of mental health.
Beyond the many variables and difficulties imposed upon the collection of high-quality data, a lack of a standardized diagnostic culture and clinical nomenclature across cultures further complicates matters. Understanding the inconsistencies in international diagnostics and incongruent nomenclature is vital.
Mental Health – Lost in Translation
Depression and anxiety are often the first and second most common mental health complaints in many global surveys. The definitions of depression and anxiety are relatively clear for those fluent in English in Western cultures and for Western mental health professionals to quantify or validate. In some cultures, however, ‘specific phobias’ are reported as the first or second most common mental health complaint.
In the Anglosphere and Western Europe, specific phobias are a rarer formal diagnosis. It is surmised that within many nations and cultures, and thus within many surveys, a ‘specific phobia’ is defined as an array of symptoms and a diagnosis that can be lost in translation several times over.
According to contemporary Western understanding of symptoms, specific phobias can overlap with some of the Western diagnostic criteria of obsessive-compulsive disorder (OCD), being obsessive concerns that can interfere with everyday life. The term “specific phobia,” for example, appears in the global class survey, conducted by McGrath et al., addressing the ages of onset of mental illnesses across 29 countries (2023). In a global class meta-analysis that sought to assess ages of onset of mental illnesses across 192 nations, the term “specific phobias” appears again – with relatively small total numbers (Solmi et al., 2022). A stark variability in the results of various global class surveys can exist, requiring professional agreement, standardization, and illumination. These cross-cultural differences are prove to be a professionally acknowledged impasse of nomenclature, nosology, and cross-cultural professional opinion (Hinton & Pollack, 2009).
Further complicating matters, PTSD is ranked globally as the third most common mental health complaint among women, according to a series of global-class surveys (“Global, Regional, and National Burden of 12 Mental Disorders in 204 Countries and Territories, 1990–2019,” 2022). PTSD can be diagnosed or classified as a dissociative disorder or as an anxiety disorder – depending on which symptoms are most prominent or which theoretical etiology is observed. People who suffer from PTSD can also experience intense reactions to various kinds of triggers; those reactions can present like the reactions that are characteristic of specific phobias. Since diagnostics are far from being formalized between cultures, these symptoms could easily be superimposed between PTSD, stress-related disorders, anxiety related disorders, and vice versa.
Survey methodologies, diagnostic culture, nomenclature, or the clinical recognition of any given mental health condition, are additional examples of the kinds of inconsistencies which can act as powerful variables to create difficulties in determining which mental health conditions are truly the most common in affluent nations.
Average Ages of Onset Across Nations
In a meta-analysis from 2022, researchers sought to determine the age at which people are first affected by the most common and impactful mental disorders (Solmi et al., 2022). This meta-analysis is salient not only due to its global scope, but also because it reveals which age groups may benefit most from early interventions to hedge against the onset of a mental health diagnosis.
The studies included in the analysis broadly focus on data-rich studies from affluent nations, largely featuring Western and Westernized cultures, but also includes numerous Eastern and Near Eastern nations and less wealthy nations. English-speaking affluent nations of the Anglosphere are most prominently represented, with 54 of the 192 studies coming from the U.S., eleven from Australia, six from Canada, five from the U.K., and three from New Zealand. Scandinavia is featured prominently, with ten of the analyzed studies coming from Finland, five from Denmark, and four from Sweden. Six studies come from the Netherlands. Western European nations are represented by eight studies from Germany, five from Spain, three from Switzerland, and two from France. Five studies come from China, five from South Africa, four from Israel, four from South Korea, and two studies each from Taiwan and Singapore. Twenty-three of the studies in the meta-analysis canvas multiple nations at once. Affluent nations from all corners of the globe are represented.
Highlighting an early average age of onset across cultures and numerous mental health disorders, the analysis reports, “Overall, before age 14, 18, and 25 years, a disorder had already emerged in 34.6%, 48.4%, and 62.5% of individuals.” (Solmi et al. 2022). Considering how mental health care treatments appear to exist between two primary groupings of ages, children (under 18 years of age) and adults (over age 18 years of ag), and that younger people are clearly more likely to experience the onset of numerous mental health conditions, an argument can easily be made against an apparent Western clinical tradition of bifurcating mental health care treatments between these two groups. Child psychologists, social workers who specialize in working with families with younger children, and school counselors, in Western nations, are examples of professional niches which specialize in the treatment and care of younger demographics. The existence of such professional specialties is a reminder that mental healthcare, historically, has greatly focused on the mental health of adults. Treating the youngest generation, statistically most likely to experience the onset of mental health concerns, is a logical safeguard for individuals living in any society. Instead of serving as a statistical bellwether for the future patient populations who might eventually seek counseling or psychotherapy in adulthood, after a diagnosis, the stunningly early ages of onset should be a call to action.
The meta-analysis includes information regarding the average age of onset (AAO) for specific groupings of disorders, many of which emerge earlier in life, yet it does not specifically address depressive disorders (Solmi et al., 2022). By age 14, for example, 38.1% of all cases of fear and anxiety-related disorders will have emerged in any individual who might be statistically likely to develop such disorders over a hypothetical lifetime. When the statistical threshold of an AOO is raised to 18 years of age, the average number of expected cases increases to 51.8%. By age 25, 73.3% of all cases are statistically likely to exist in any given individual who will suffer from any of the anxiety and fear-related classifications of disorders. Thus, nearly three-quarters of all anxiety and fear-related disorders are most likely to emerge before age 25, more than half will emerge before age 18, and well over one-third of all cases will be diagnosed before the age of 14.
Disorders associated with life stressors (e.g. trauma, grief, adverse childhood events (ACEs), or any unfavorable social determinants of mental health) see 16.9% of all cases diagnosed by age 14 (Solmi et al., 2022). When the average age of onset for a stress-related disorder is increased to a threshold of 18 and 25, the average rates increase to 27.6% and 43.1%, respectively. Thus, over two-fifths of all disorders that are diagnosed as being associated with clinically concerning trauma and stress occur in the lives of young people.
Mood disorders, by age 14, show an average of only 2.5% of all cases having been statistically likely to be diagnosed (Solmi et al., 2022). These rates increase to 11.5% by age 18 and to 34.5% by age 25. Substance abuse and addictions are similarly uncommon at age 14, with only 2.9% of all lifetime cases emerging by this age, on average. The figure for addictions rises to 15.2% by age 18 and 47.8% by age 25. Thus, by age 25, nearly half of those who will eventually suffer from substance abuse disorders will have begun to consume substances. The study includes similar figures for anorexia nervosa, bulimia nervosa, OCD, and binge eating disorders, all of which are statistically likely to emerge between early adolescence and young adulthood. Conversely, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), depressive disorders, and bipolar disorders are more likely to emerge in adulthood.
The early age of onset for so many mental health disorders indicates that access to effective care in the form of prevention and early intervention is clearly a worthy form of infrastructure to develop, maintain, and reinforce. Since many of these disorders remain of an unknown etiology and have no known cures, psychotherapy and counseling often serve to provide relief and resolution. Focus upon treating a younger demographic is clearly worthy of a strategic shift in praxis for all related professional spheres and is an obvious reply to match real-world demand.
Global Rates
When assessing the overarching categories of mental health concerns of all nations (including the affluent nations which embrace psychotherapy), it is essential to reinforce the tenet that nomenclature, nosology, and professional recognition will vary between cultures. A subtle nuance in how a specific disorder is diagnosed, for example, could create confusion between clinicians in different cultures. A major disparity could also arise when one culture acknowledges a disorder while another culture does not. While this is not regularly the case among affluent nations, disparities of clinical recognitions do arise. Standardization efforts are underway, evidenced by the professional bodies that publish the diagnostic and coding guides such as the DSM-5 and the ICD-11. Despite ongoing efforts of medical standardizations, as of 2025, the lack of an internationally unified clinical standard for mental health diagnostics requires the use of dynamically evolving definitions to make sense of the statistics presented by global class mental health surveys.
A cross-sectional global class analysis of mental health, surveying 29 countries included 156,331 respondents across multiple World Health Organization (WHO) surveys, sought to update assessments of prior analyses that had been completed sixteen years prior (McGrath et al., 2023). The study is valuable due to its size and for its inclusion of many affluent and psychotherapy-affirming nations. Seventeen of the twenty-nine surveyed nations were classified as high-income affluent nations. This cross-sectional analysis revealed the top three mental health concerns for the adults surveyed.
The top three mental health concerns of men (comprising 45% of the total number of people surveyed) are alcohol abuse, depression, and specific phobias (McGrath et al., 2023). The top three mental health concerns of women are depression, specific phobias, and PTSD. The analysis also determined that over half of all people are likely to suffer from a mental health concern over any given lifetime.
When drawing from WHO data sets instead, mood disorders (primarily comprised of the various kinds and severities of depressions), anxiety disorders (comprised of generalized anxiety, social anxiety, panic disorder, specific phobias, etc.), and stress-related disorders (comprised of life-stressors or trauma-related disorders, dissociative disorders, and burnout), are the three most common overarching varieties mental health complaints in the affluent and psychotherapy-affirming world (“Global, Regional, and National Burden of 12 Mental Disorders in 204 Countries and Territories, 1990–2019,” 2022).
The Institute for Health Metrics and Evaluation (IHME), the administrator of the databases of the Global Health Data Exchange (GHDx), sheds light upon the total number of individuals who suffer from the two most common mental health concerns in the nations designated in the database as ‘high-income.’ The IHME is a major public health research institute, a collaborator of the WHO, and a partner of the Centers for Disease control (CDC). Drawing from a variety of data sources and employing complex analytical techniques, the IHME estimates the total prevalence (of all ages and genders and rounded up to a whole number) of anxiety disorders in these affluent nations to be 359,213,270. The upper estimate is 419,966,576, and the lower estimate is 307,185,425 of total sufferers of anxiety disorders over some point of a life, either transient or chronic (GBD Results, n.d.). If the same parameters are used to find the total prevalence for depressive disorders (i.e., MDD and Dysthymia), the estimated prevalence is 332,410,333 affected individuals – with an upper limit of 376,102,441 and a lower limit of 297,742,040. The database does not address PTSD nor stress-related disorders and does not mention the semantically troublesome diagnosis of ‘specific phobia.’ It remains unclear if these disorders are featured in the IMHE by a different name.
The definitions of every disorder included in this section of the IMHE database are vague by default and require interpretation when comparisons to results of different overarching sources are necessary. It is relatively easy to circumvent impasses created by international variations in nomenclature, however: the most common mental health disorders can be grouped together in several overarching categories.
Depression
Depression, like most mental health concerns, is generally diagnosed via the presence of a constellation of symptoms as presented by the patient. Depressive disorders include major depressive disorder (MDD), persistent depressive disorder (PDD/Dysthymia), and seasonal affective disorder (SAD) (World Health Organization, 2022). Some depressive disorders are unique to women (e.g. premenstrual dysphoric disorder, prenatal depression, postpartum depression) (World Health Organization, 2022). Variations of depression are often present while grieving, can occur reactively in response to stressors or trauma, and can present comorbidly with other mood and anxiety disorders such as bipolar disorder, cyclothymia, eating disorders, anxiety disorders, et alia (World Health Organization, 2022). Diagnostic considerations for a proper differential diagnosis are numerous within the ICD-11 (World Health Organization, 2022).
An in-depth article by Cui et al. (2024) examines contemporary western medicine’s search for the etiologies and treatments of the many variations of depressive symptoms and diagnosable depressive disorders. Cui et al. note that Western medicine often relies upon the prescription of pharmaceuticals in the treatment of the various forms of depression, yet many patients with MDD and the most severe manifestations of depressions fail to find relief from pharmacological treatments alone. Individuals who are at risk of a depressive episode can benefit from preventative measures (e.g. nutrition, exercise, lifestyle changes, consistent therapy), often as directed by therapists. The researchers conclude that pharmacological interventions for depressions are vastly more effective when paired with consistent evidence-based psychotherapy. This research reveals a need for well-trained psychotherapists who can effectively treat any such still-incurable disease – whether by pharmacological measures paired with therapy, psychotherapy without medication, or a combination of multiple forms of therapy at once. Nearly all forms of depression, even recalcitrant cases, benefit in some way from consistent psychotherapeutic support.
Depressions Defined
A common understanding of depression is a lack of interest in pleasurable activities – in fact, an ongoing anhedonia is a hallmark of almost all mood disturbances. The manifestations of a mood disturbance go far beyond a person “having a case of the blues,” experiencing a random and fleeting feeling of melancholy, or experiencing an intense feeling of grief in the face of loss. Any day-to-day disruptions of a person’s ability to function in the ways that they are used to functioning can impact their perceived sense of wellbeing. Depressive disorders often share overlapping symptoms with myriad mental health complaints, are regularly accompanied by anxieties, and share similarities to many normal kinds of life experiences.
Depressions and mood disorders generally disrupt a person’s ability to function. These can affect a person’s social life, their close interpersonal relationships, or how they interface with their society. Physiologic impacts like insomnia, somnolence, and changes in diet can lead to malnutrition, weight loss or weight gain, and can further diminish energy levels, impacting cognition and compounding depressive symptoms. Cognitive components of a depressed mood can include trouble concentrating, trouble making decisions, decreased motivation, rumination, feelings of worthlessness, feelings of guilt, suicidal ideation, and despair. Stein et al. (2020) summarize the updated diagnostic criteria of the ICD-11, stating, “The ten symptoms of depression are depressed mood, markedly diminished interest or pleasure in activities, reduced ability to concentrate and sustain attention or marked indecisiveness, beliefs of low self-worth or excessive or inappropriate guilt, hopelessness about the future, recurrent thoughts of death or suicidal ideation or evidence of attempted suicide, significantly disrupted sleep or excessive sleep, significant changes in appetite or weight, psychomotor agitation or retardation, and reduced energy or fatigue.” The authors note that five of the ten ICD-11 diagnostic criteria must be present daily, in some capacity, for at least two concurrent weeks for a depressive episode to be diagnosed. That said, there are many caveats in the diagnostic guidelines for differential diagnoses, revealing the regularity in which depressive symptoms occur in proximity to distinctly different mental health concerns (World Health Organization, 2022). When depressive episodes are recurrent, severe, or when an individual experiences varying degrees of depression over more extreme lengths of time, clinicians are likely to diagnose the more chronic and life-impeding forms of depression.
Depression in the United States
Younger generations appear to be the demographic that is most likely to be affected by depression; moreover, they are most likely to suffer from a depressive episode if they live in an affluent nation. A 2019 analysis focusing on cohorts from the United States, consisting of surveys conducted between 2005-2017 with responses from 212,913 adolescents (aged 12-17 years), and similar surveys conducted between 2008-2017 with responses from 398,967 adults (18 years of age or more) indicates that mood disorders, largely consisting of major depression, had risen distinctively (Twenge et al., 2019).
According to the data, rates of a major depressive episode in any given year from 2005-2017 had increased by 52% (Twenge et al., 2019). If only the years 2009-2017 are viewed, the rates of a reported major depressive episode increase to 63%. This illustrates a stark acceleration of depressive mood disturbances over time. Major psychological distress, defined by the authors to include suicidal ideation and attempted suicides, increased greatly in younger adults aged 18-25, with a 71% increase in reports of major psychological distress in any given year between 2008-2017.
While the United States does feature some of the highest reported rates of the most-commonly diagnosed mental health concerns, such diagnoses are either present or rising in one capacity or another in numerous affluent nations. The authors note that across cohorts, women and individuals who were socioeconomically wealthier were most likely to report depressive episodes and the most severe forms of depression. Interestingly, socioeconomically poorer respondents of minority groups were slightly less likely to suffer depressive episodes. Wealthier non-Hispanic white female adolescents and young adults were singularly most likely to suffer depression – and its most severe, debilitating, life-impacting forms.
Depression Globally
In “Major Depressive Disorder,” a global class analysis drawing from World Mental Health (WMH) surveys, the authors uncover much salient information regarding the global magnitude of depression (Bromet et al., 2018). The WHO World Mental Health Surveys Initiative, the authors note, was created to address a lack of standardization that had impacted many previous surveys across political and cultural borders of some WMH nations. The average prevalence of MDD over a lifetime, of the twenty-nine WMH nations surveyed, was 10.6%.
The highest prevalences of MDD over a lifetime were found in socioeconomically affluent nations (Bromet et al., 2018). In the Anglosphere, the lifetime prevalence of MDD was 13.5 % in Australia, 16.3% in New Zealand, 16.3% in Northern Ireland, and 16.9% in the United States. In Europe, the lifetime prevalence of MDD was 14.1% in Belgium, 21% in France, 9.9% in Germany, 9.9% in Italy, 3% in Poland, 16.7% in Portugal, 10.6% in Spain, 13.8% in Murcia (an autonomous region of Spain), and 17.9% in The Netherlands. Israel’s lifetime prevalence rates of MDD were 9.9%, while Japan’s rates were also notable, with only 6.1% of the population being expected to suffer from MDD over a lifetime.
The authors uncover several interesting trends. Divorcees were slightly more likely to suffer from depression than people who were still married (Bromet et al., 2018). Women have twice the risk for developing a depressive episode, though for persistent forms of depression (e.g. MDD or PDD), men and women share similar rates over a lifetime. Educated individuals and college graduates share a correlation with a lower overall risk of depression across nations and cultures. Being outside of the workforce doubles the odds of a person developing MDD. Half of the total number of MDD cases that were firmly diagnosable, the authors assert, could additionally qualify for a diagnosis of a lifelong anxiety disorder, evidencing the clear comorbidity that exists between mood disturbances. In the analysis, MDD rarely preceded the age of onset (AOO) for anxiety disorders, impulse-control disorders, or substance use disorders. The AOO of these disorders is in adolescence. A diagnosis of comorbid MDD is most likely to be acquired slightly later in life, in early young adulthood; depression is a common comorbidity.
In affluent nations, rates of depression are shown to decline with age, while in less wealthy nations, age correlates with increased overall rates of depression (Bromet et al., 2018). The authors note a variability in response rates between wealthier and poorer nations. Despite substantially more responses coming from affluent nations, their prior work indicated the lower response rates of poorer nations did not correlate with a decreased prevalence of depressions. The authors also point out that households were a primary source of responses. Some demographics that were less likely to participate in the surveys included incarcerated individuals, individuals receiving in-patient medical care, residents of military bases, and intoxicated individuals. As a result, the authors state that their estimates of the rates of depression should be regarded as highly conservative figures.
The study concludes with the fact that depression is recognized as the second leading cause of years lived with disability (YLDs) (Bromet et al., 2018). The global impact of depression is immense, and rates could be rising. Societal impacts appear to affect the wealthiest nations most, as the affluent individual who comprises any affluent nation may statistically be most prone to suffer.
Anxieties and Fear-Related Disorders
Anxiety and Fear-Related Disorders Differentiated
Anxiety and fear-related disorders include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, agoraphobia, specific phobias, selective mutism, and separation anxiety disorder, among others (World health Organization, 2022). This overarching category covers an immense spectrum of possibilities in terms of the kinds of symptoms that any given patient might experience. Anxiety disorders are generally viewed as something distinct from mood disorders, though interestingly, there is a growing consensus among researchers that GAD shares more in common with major depression than the other disorders of anxiety or fear (Stein et al., 2020). The symptoms of anxiety and fear-related disorders are regularly comorbid with other mental health concerns, though millions of lives are affected by the diagnosis of an anxiety disorder without the presence of any comorbid diagnoses.
Historically, anxiety disorders and obsessive disorders had appeared to share many symptoms and were thus grouped together in the ICD-10 under the umbrella of “neurotic, stress-related, and somatoform disorders,” (Stein et al., 2020). Concerns surrounding the etiology and diagnostic criteria for specific phobias and anxiety-related disorders were addressed in the ICD-11 (World health Organization, 2022). The ICD-11 also saw the creation of a new diagnostic category, “anxiety or fear-related disorders,” encompassing all anxiety disorders, thus classifying them separately from obsessive disorders (Stein et al., 2020). Obsessive disorders (e.g., body focused repetitive disorders, OCD), in turn, received their own diagnostic category, “obsessive-compulsive or related disorders.” Hypochondriasis, no longer classed as a somatoform disorder, was reclassified within the new obsessive disorders category. The symptoms of repetitive mental acts – thought processes which exist independently of obsessive behaviors – were formerly recognized and categorized alongside obsessive disorders. Despite how common obsessive disorders are, globally, these new classifications minimize the need to differentiate an obsessive-related disorder from an anxiety-related disorder for the purposes of assessing the historic, contemporary, and future rates of mental health concerns. Potentially a confounding factor for diagnosing professionals, individuals who suffer from these disorders are statistically likely to suffer from them comorbidly. Improvements in nosology and etiology can nonetheless create clarity within the diagnostic process, aid in the creation treatment plans, and subsequently lead to better outcomes for patients.
The ICD-11 also updates panic disorder to includes a person’s fearful preoccupation of having panic attacks alongside any shifts in their daily behaviors that can be attributed to avoiding a panic attack (Stein et al., 2020). This helpfully differentiates panic disorder from a trauma or stress-related disorder like PTSD that can feature anxiety attacks or panic attacks. Panic disorder and agoraphobia are classed similarly and are often grouped together across theorized etiologies yet can be comorbid with numerous other disorders.
The shifts within the ICD-11 align it more closely with corresponding entries in the DSM-V (Stein et al., 2020). The ongoing process of establishing an international consensus on diagnostic criteria is evidenced in updates to these two prominent diagnostic and coding guides. Future updates to ICD and DSM publications may eventually serve to minimize the discrepancies between global class surveys, yet more importantly, might serve to increase the accuracy of mental health diagnoses as an initial component to effective treatment. The necessitated efforts within the professional medical spheres to achieve clinical standardizations is quite pronounced with the variations found in the international recognitions of anxiety and fear-related disorders.
In “Introduction to the Special Issue: Anxiety Disorders in Cross-Cultural Perspective,” the authors disseminate the varying presentations of anxieties across cultures (Hinton & Pollack, 2009). Anxiety disorders present very differently due to cultural biases. One culture might be highly superstitious, for example, so an individual’s anxiety attacks or ruminations involving irrational fears and supernatural beliefs could be viewed as normal, and result in the person being diagnosed with an anxiety disorder instead of with delusions – or even result in the individual being diagnosed as normal and otherwise healthy. In a second culture, such beliefs could largely be rejected as abnormal and judged as irrational, obsessive, delusional, phobic, etc., and could result in a diagnosis of a severe mental illness. The recognized and culturally validated signs and symptoms of anxiety and fear can vary substantially between cultures as well. The many unique culturally bound syndromes are stark examples in this respect. A more nuanced example might involve how one culture could view cold sweats and a racing heart as a normal aspect of public speaking and nervousness, whereas another culture might implicate those non-phobic symptoms of anxiety as a personal shortcoming or irrational fear.
The combinations of the recognition and interpretation of anxious symptoms, as constructs, are virtually endless within any given culture’s collective beliefs and biases. Despite any cognitions, emotions, affects, beliefs, or circumstances which might induce the symptoms of anxiety disorders in any given person, all cultures seem to acknowledge some core aspects of the human condition at the physiological level. Symptoms like a racing heart, racing thoughts, various kinds of severe indigestion, shaking, a feeling of impending doom, a fear of death, and other symptoms of an intense anxious and fearful distress, leave little room for interpretation. Further, comorbidities can cause or amplify any physical, emotional, cognitive, or social aspects of anxiety and fear-related disorders, and vice versa.
Kalin (2022) examined the complex interconnections across all psychiatric disorders – and the statistical normalcy of the presence of comorbidities in any given patient. Across the various anxiety disorders assessed, rates of comorbid depression ranged from 20% to 70% and generally began before adulthood.
Across all psychiatric disorders, with comorbidities clearly being the rule rather than the exception, it is imperative to make differential diagnoses with a nuanced, individualized, and culturally-informed approach to treatment options. Across and between cultures, human beings who have anxiety and fear-related disorders can benefit from and do respond to consistent psychotherapy.
Defining Anxiety and Fear-Related Disorders
The article “Generalised [sic] Anxiety Disorder and Depression: Contemporary Treatment” helps to tackle the difficult task of creating a succinct definition encompassing all anxiety disorders (Goodwin & Stein, 2021). Anxiety disorders are a huge and often-overlapping spectrum and/or dimension of symptoms and disorder with etiologies, taxonomies, and related terminologies that are complex and ever-evolving. The description of anxiety and fear-related disorders in the ICD-11 involves a presence of excessive anxiety or fear in a person’s life that produces substantial impacts to their normal way of living (ICD-11 for Mortality and Morbidity Statistics, n.d.). Anxiety and fear can create or include disturbances to a person’s normal behaviors and their routine life, affecting professional, social, educational, or familial life, close relationships, moods, etc. The anxieties and fears may be very specific or broad-ranging. Fear-related disorders tend to focus upon specific triggers which may occur in the very near future, whereas anxiety disorders tend to focus on future scenarios.
Generalized Anxiety Disorder vs. Anxieties and Fears
Concurrent themes regarding the existence, recognition, and diagnosis of generalized anxiety disorder (GAD) involves a constant flux between various theoretical standpoints. Pathologizing the anxieties which are a normal and natural component of the human condition, for example, can easily be overextended into treating life itself as a clinical condition. That said, having a general or consuming feeling of anxiety that impedes a person’s ability to function or thrive is, by definition, far more impactful than any normal kinds of anxiety. The subjectivity of patients and clinical professionals creates a difficulty in refraining from pathologizing normal life while also ensuring that all individuals who suffer from clinical anxiety disorders receive the support and care they seek.
Stark changes in the global statistics of individuals who suffer from GAD and at least one comorbid diagnosis, as defined by DSM-VI standards and DSM-V standards, illustrates the evolving definition and recognition of the disorder (Ruscio et al., 2018). Individuals diagnosed with GAD via DSM-VI criteria, for example, had a 76% chance of having at least one additional psychiatric condition of any kind. If the DSM-V metrics are considered instead, the chances of an individual suffering from GAD and at least one additional psychiatric condition rise to 82% – a difference of 6%. A 6% increase or decrease of the likelihood of suffering from GAD and at least one comorbid disorder is an alarmingly high statistical variation between two iterations of a diagnostic framework. These variations become even more distinctly surprising for individuals assessed as suffering from GAD within a 12-month period, however. When 12-month cases were assessed via DSM-VI norms, individuals were thought to have a 57% likelihood of also having any other psychiatric comorbidity, while individuals assessed via the DSM-V standards were given a likelihood of 70%. For the 12-month cases assessed, the percentage the difference between the two frameworks was 13%. While the population has grown, the simple math is static; plus or minus 6% and plus or minus 13% is a contrast between diagnostics that should arouse the skepticism of any rational minds.
While the diagnostic criteria for GAD and the resulting statistics are in a state of regular flux, so are the criteria and the professional recognitions of the disorder. It is nonetheless valuable for clinicians to hold in mind that any patient with any mental health complaint is likely to suffer from anxieties or fears. Recognizing that individuals numbering in the tens (and perhaps hundreds) of millions live with either chronic anxiety, transient anxiety, or fear, is an awareness that carries gravitas. Treatment options for anxiety disorders like GAD often focus on coping with the anxious symptoms. GAD and anxiety disorders are shown to respond well to preventative measures that are implemented, ideally, long before a formal case develops into a diagnosis (Goodwin & Stein, 2021). The growing body of empirical evidence indicating a co-existence of GAD and MDD suggests that GAD may have more in common with MDD than with other anxiety and fear-related disorders. It is interesting to note that there is a single new diagnosis of “anxious depression,” as well as a comorbid diagnosis of both depressive disorder and an anxiety disorder; regardless of whether these prove to be one and the same in the future, they are known to respond well to many well-established therapies (Kalin, 2020). For patients, labels are far less useful than their individual outcomes from effective therapies. As a result of the comorbidity and the difficulty of isolating GAD from other kinds of anxiety, it is less useful to try to quantify the true numbers of people who suffer of GAD outright in favor of accepting that anxiety that creates disorder in a person’s life is something to be expected and cared for along any other diagnoses they might carry.
Panic Disorder and Agoraphobia
The terms “anxiety attack” and “panic attack” often suffer from interchangeable use in conversational English, though they are quite different. “Anxiety attacks” are not a formal diagnosis. While anxiety is a component of the human condition, the severity, frequency, triggers, and durations of anxieties can differentiate normal experiences and feelings (e.g. apprehension, nervousness, worry, rational fear) from the recurrent and severe kinds of anxiety which might indicate the presence of a disorder. A panic attack (PA), however, is a recognized symptom of disorder. A series of panic attacks can constitute panic disorder (PD). The ICD-11 entry for panic disorder states “Panic Disorder is characterized by recurrent unexpected panic attacks that are not restricted to particular stimuli or situations,” (ICD-11 for Mortality and Morbidity Statistics, n.d.). Panic attacks are described as episodes of intense fear or apprehension alongside the rapid onset of specific symptoms, many of which are primarily a physiologic response that can be associated with the fight/flight/freeze response and the release of adrenaline. These symptoms can include heart palpitations, a ‘racing heart’, chest pain and shortness of breath, skin sensations and responses like sweating, chills, or hot flashes, feeling dizzy and lightheadedness, trembling, and a pronounced fear or feeling of dying. A diagnosis of panic disorder includes a person’s fear of experiencing panic attacks and the behaviors they undertake to avoid those experiences.
De Jonge et al. (2018) conducted a study assessing the global prevalence of panic attacks and panic disorders, drawing from 147,264 participants across 25 countries, and featuring 15 high-income countries. Four of these affluent nations (Australia, New Zealand, Northern Ireland, and the United States) represent the Anglosphere. Nine represent Europe (Belgium, France, Germany, Italy, Poland, Portugal, Spain, the autonomous region of Murcia, and The Netherlands). Israel and Japan are also included. While this study bridges some criteria from the DSM-VI and DSM-V, it is noted that the definition of panic attacks has remained comparable across the third, fourth, and fifth editions of the DSM.
While a diagnosis of panic disorder is relatively uncommon, the study also indicates that panic attacks are a relatively common experience (de Jonge et al., 2018). A 1.7% lifetime prevalence of panic disorder and a projected lifetime risk of panic disorder 2.7% (by age 75) across the nations surveyed may seem less significant than other anxiety disorders, yet 13.2% of respondents reported experiencing one or more panic attacks. The study suggests that the presence of recurrent panic attacks in any individual is a strong marker for psychopathology, reinforcing a decision made to include panic attacks as a generic severity marker in the DSM-V. Despite being uncommon, panic disorder is highlighted as being an extremely debilitating, with 45.7% of respondents who have suffered from panic disorder for 12 months reporting role impairments within their close relationships, social lives, professional lives, or at home. Role impairments are difficulties that a person experiences in being able to function in the ways that might normally be expected of them. Role impairments are a sign or a symptom of many disorders and mental health concerns. In cases of PD (and the more severe variations of the most common mental health disorders), severe role impairments can contribute to the loss of social relationships, professions, intimate relationships, and the ability to otherwise function normally in day-to-day life.
Agoraphobia shares many similarities with traditional phobias, with avoidant behaviors being prominent (Roest et al., 2018). Agoraphobia is associated with panic disorder and can be diagnosed as an aspect of panic disorder, though Agoraphobia can be diagnosed on its own when recurrent panic attacks are absent from a person’s symptoms. The symptoms of agoraphobia can primarily involve the distress a person experiences when they are away from home. Simply being in certain public spaces, like large crowds, busy urban environments, auditoriums, theaters, standing in lines, or traveling in planes, trains, or automobiles of any size or seating capacity, and the distress or discomfort that ensues, are some hallmarks which may or may not be present (ICD-11 for Mortality and Morbidity Statistics, n.d.). A common theme of agoraphobia is a feeling of being unable to leave or escape from those public, social, or transportational situations, making specific rules or conditions before leaving home to be in such spaces, and a debilitating fear or anxiety that is experienced either in those kinds of spaces or when thinking about such situations beforehand. Professional speculation surrounding agoraphobia involves efforts to determine if it is a distinct disorder or if is it is an array of symptoms that can accompany other disorders (Roest et al., 2018). Individuals diagnosed with agoraphobia, with or without a diagnosis of panic disorder over a lifetime, have an 88.8% likelihood of having another mental health disorder. The list of common comorbidities is lengthy, including social anxiety disorder (50.2%), specific phobia (41.2%), GAD (29.4%), PTSD (21%), and (55.1%) of all agoraphobia cases sharing a comorbid mood disorder – largely depression.
Notably, many of the common and relatively milder comorbidities of social phobias, agoraphobia, and panic disorders, are less difficult to treat and respond well to supportive measures and consistent psychotherapy.
Social Anxiety Disorder
Social anxiety disorder (SAD) can be described as an excessive fear or anxiety that occurs in social situations, a feeling of being observed or judged by others within those social settings, and an overarching concern of behaving in a way that will cause others to view or judge oneself negatively (ICD-11 for Mortality and Morbidity Statistics, n.d.). A sufferer of social anxiety might be afraid that their own symptoms could produce negative social judgements. As a result, sufferers will consistently avoid social situations. If sufferers do choose to endure the applicable social situations which cause their apprehension and anxiety, they may experience intense fear or anxiety within that setting.
The clinical recognition of social anxiety disorder, according to the authors of a 2018 study which examined the global prevalence of the disorder, is a nosologically debatable construct that has been recognized only very recently in humanity’s history (Stein et al., 2018). The DSM-III included diagnostic criteria for ‘Social Phobia’ which then evolved to ‘Social Phobia (Social Anxiety Disorder)’ in the DSM-IV, only to become ‘Social Anxiety Disorder (Social Phobia)’ in the DSM-V. The debate largely attempts to delineate social anxiety from social phobias; sufferers of social anxiety tend to lack the avoidance behaviors that are generally more pronounced in cases of phobias, including social phobias. Further still, anxiety, nervousness, nervousness in the anticipation of social settings, or anxiety felt by an individual within certain settings are self-evidently components of the human condition. Nervousness, feelings of apprehension, anxiety, and fear responses are all very similar; nervousness and outright anxiety are difficult to disentangle and are hopelessly subjective, like many symptoms of mental health concerns.
In the study “Social Anxiety Disorder,” 13 high-income nations (Australia, Belgium, France, Germany, Italy, Japan, New Zealand, Northern Ireland, Poland, Portugal, Spain, The Netherlands, and United States) were assessed alongside 7 middle income nations and six lower income nations (Stein et al., 2018). Across all countries, 30-day rates of SAD were 1.3%, 12-month rates were 2.4%, and lifelong rates were 4.0%. While social anxiety disorder is prevalent globally, affluent nations once again show the highest overall rates and lifetime prevalences of the disorder. The affluent nations of the Americas and the Western Pacific featured the highest rates of all.
People diagnosed with lifelong cases of SAD often suffer from other mental health disorders (Stein et al., 2018). Some of the most common comorbidities of individuals diagnosed with SAD include mood disorders (47%, depression or bipolar spectrum), an additional anxiety disorder (59.8%), a disruptive behavior/impulse-control disorder (19.3%), or a substance abuse disorder (26.7%). Suffers of SAD have a 78.8% chance of being diagnosed with at least one additional mental health disorder.
Cross-cultural elements are extreme confounding factors in this work; creeds and customs diverge and vary within the human diaspora. The fear of offending other people, for example, is a normal aspect of socializing that is difficult for some professionals to pathologize, while the fear of public speaking is a form of social anxiety that is extremely common – even in non-neurodivergent individuals.
Specific Phobias
Specific phobias deserve additional attention due to their occasional and ostensibly disproportionate presence in some global surveys of mental health. By Western standards, specific phobias include an excessive fear or anxiety that occurs when a person is exposed to (or mentally anticipates exposure to) the object of their phobia (ICD-11 for Mortality and Morbidity Statistics, n.d.). Those excessive fears or anxieties are judged to be exaggerated in terms of the actual risks surrounding the object (the trigger) of their phobia and are thus considered to be irrational fears. Excessive fears or extreme anxiety created by a specific phobia can consistently impede a person’s way of life and cause them great distress for substantial periods over their lifetime.
Common specific phobias include fear of specific animals, fear of flying, fear of heights, fear of open or still bodies of water, fear of certain kinds of weather, fear of tight and confined spaces, fear of injections or medical procedures, and fear of blood. Ancient Greek roots are used to ascribe the prefix of specific phobia; the imagination can be used to invent new or unlikely phobias. All truly phobic reactions, however, are characterized clinically as intense and severe with good cause. Phobias can substantially interfere with socioeconomic, social, professional, emotional, romantic, behavioral, or physiologic wellbeing, and impacting the day-to-day functioning of a person who suffers.
In a 2017 analysis, “The cross-national epidemiology of specific phobia in the World Mental Health Surveys,” of the 22 nations surveyed, 12 nations (Belgium, France, Germany, Italy, Japan, Netherlands, New Zealand, Northern Ireland, Poland, Portugal, Spain and the United States) are classed as ‘high income’ (Wardenaar et al., 2017). The median AOO across cultures for specific phobias was between only eight and nine years of age. Across roughly 60.5% of lifetime specific phobia cases, at least one comorbidity was present. Across all cases, 34.3% were also diagnosed with a mood disorder, 41.2% with an anxiety disorder, 15.9% with a substance-use disorder, and 17.4% with an impulse control disorder. The cross-national lifetime prevalence of specific phobias was 7.4%, with women being more likely to have a specific phobia than men, and those who work being less likely to suffer than those who are unemployed. Prevalence was much higher in high-income nations, as was the duration of a phobia and the level of impairment reported by individuals surveyed. Being and remaining married and having higher levels of overall education were associated with a lower overall risk.
As previously noted, international variations of nomenclature, recognition, or diagnostic culture may impact global assessments of mental health. It is surmised that anxiety disorders are sometimes conflated with specific phobias and vice versa, while survey methods and additional confounding variables surely muddy the proverbial waters further. When anxiety disorders and specific phobias are added together and averaged within or across global class surveys, the results nonetheless remain in the top three of all global mental health concerns. In the affluent world, without the inclusion of specific phobias, anxiety disorders irrefutably meet the criteria for one of the most common mental health disorders.
Stress, Trauma, and Substance Misuse
Trauma and stress-related disorders form an overarching category of mental health concerns and usually ranks as the third most common grouping across global surveys. The disorders which comprise this overarching category are not always well defined within global surveys. While the statistics are bound to vary substantially across international borders, PTSD is by far the most common diagnosis among the affluent nations. The various dissociative disorders and occupational burnout are additional examples. Regarding PTSD, both genders are affected, though women are somewhat more likely to suffer from PTSD than men.
Substance abuse garners additional consideration due to how the disorders can be acquired by someone who does not have a genetic predisposition toward addictions. Alcohol and substance use appears regularly in global surveys of mental health and occasionally registers as more prominent than the disorders of trauma and stress for men. The prevalence of substance abuse is an especially important consideration for clinicians because patients who already suffer from a mental health disorder are, sadly, more likely to abuse substances. Substance abuse disorders exist across the sociodemographic spectra, globally. Many cases can be fully treatable with psychotherapy and the dedication of a patient; all cases are treatable. Substance abuse disorders are an essential example of a mental health concern that highlights the benefits of early interventions and harm reduction.
Projected Global Rates
When data from global surveys are utilized to project the future rates of mental health concerns within the affluent world, mood disorders and anxiety-related disorders remain as the most common. It is important to remember, however, that various types of depression might sometimes be classified under the umbrella of mood disorders; likewise, specific phobias, stress disorders, and trauma-related disorders might be classed under the umbrella of anxiety disorders.
An elegantly concise study concerning depression, “Change in the global burden of depression from 1990-2019 and its prediction for 2030,” examines data from the Global Burden of Disease databases involving the global rates of depression from 1990 to 2019. In addition to data concerning depression, core demographics such as age, sex, and socio-demographic indices were assessed across numerous global regions (Zhang et al., 2024). Predicting the rates of depressions from 2020 to 2030, globally, the rigorously well-controlled models suggest that depression would exist as a remarkably stable diagnosis in terms of incidence and new cases.
Contemporarily the most common mental health diagnosis and the second-leading contributor to the global burden of disease, two counteracting factors combine into a projected overall increase in the total cases of depressions by 2030 (Zhang et al., 2024). Between 1990 and 2019, globally, the age-standardized incidence rates of depression decreased from 3.68 to 3.59, a decline of 2.45%. The estimated annual percentage change was projected as a -0.24 %. Across demographics by 2030, the odds of being diagnosed with depression are forecast to be slightly lower within a global population. The global population is, however, expected to grow. When these favorable decreased incidence rates of depression are applied to the larger global population, more total cases are thus expected. The authors note that depression may become the leading contributor to the global burden of disease as populations grow – a remarkably powerful statistical result and clinical consideration.
The trends from the study and analysis corroborate well with other studies (Zhang et al., 2024). Results indicate that affluent nations are and will be affected most. Women, particularly wealthier women living in affluent nations, are most likely to report depression. Similarly, being wealthier, divorced, having children, being unemployed, and having less overall education are common correlations with the rates of depression.
Focusing on global populations over the next three decades, a study of a similar scope underscores how MDD is underdiagnosed and undertreated while also indicating that rates of MDD are accelerating within the aging and elderly populations across the sociodemographic index. (Wang et al., 2025). The growing and aging populations of less wealthy nations are forecast to feature a greater prevalence of MDD over the next three decades. Older and aging males of less wealthy nations are projected to be most impacted. Financial insecurities are projected to be a growing contributing factor to the heightened expected global rates of MDD. For example, older men living in Sub-Saharan Africa evidenced the highest growing projected risk. Limitations of the study include the lack of high-quality epidemiological data from many nations (a known issue among contemporary global surveys), the palpable impact of the COVID pandemic (being an impetus of the authors to study global rates of MDD), the inclusion of some data/results from less-formal online surveys, and how data concerning any predictive risk factors for MDD are rare in general. Interestingly, the longitudinal increases in prevalence of MDD in poorer nations over the next thirty years would also more closely align their overall rates of MDD with the affluent nations of the present day.
According to Wang et al. (2025), the global projected prevalence of MDD may increase from 4.26% in 2021 to 4.53% in 2050. This overall increase of MDD cases suggests an estimated 97.04 million people will be living with MDD in 2050. Such estimates offer sobering figures for the possible impacts of YLDs or DALYS, and underscores the need for early interventions, effective treatment options, and therapists.
Chen et al. (2025) sought to determine the future impacts of anxiety disorders worldwide. The authors drew from the WHO’s 2021 GBD study, which included data collected from 204 countries and regions to assess the global trajectories of anxiety disorders from 2022 to 2050. The initial results show that global burden of anxiety disorders has been substantially increasing over the past two decades with a consistent upward trend between 1990 and 2021 that is expected to continue. The study notes unusually high rates within Latin American regions, a unique pandemic-era spike of new cases of anxiety disorders in Bulgaria, and the ongoing heightened rates of anxiety disorders in affluent regions and among wealthier women. The highest changes in rates of anxiety related complaints across nations and cultures have shifted, however, appearing more common in women aged 20 to 24 with a total change rate of 0.214. Slightly younger women, aged 15 to 19, also had a statistically accelerating rate of 0.209 for anxiety related issues. When both genders are observed between the ages of 20 and 24 years, a high change rate of 0.20 remains present. Anxiety and fear related mental health complaints were historically most common in women older than 24 years of age living in affluent nations. Recent data and analyses again reinforce a veritable precept: younger people, most often females, have the highest rates of anxiety-related concerns. Importantly, while the age of onset for most mental health complaints appears to be shifting younger, this trend is particularly true for anxiety-related concerns.
Chen et al. (2025) suggest these increases and demographic shifts could be due, in part, to increased awareness, better access to mental healthcare, better diagnostics, and the usual cultural concerns of the stressors of living in modern societies, the impacts of technology, smartphones, and social media. More people being aware of and seeking help for mental health concerns inevitably generates higher figures. The findings and projections of Chen et al. do not describe why the younger people in affluent nations are now more likely to be affected earlier in life. Cultural shifts paralleled (or driven by) by rapidly advancing technologies surely add stress to the lives of most people, demand adaptation from the human condition in general, and can impede an individual’s ability to cope reliably and healthfully.
In perhaps the most elegant and clearcut of studies to examine global forecasts of mental disorders, Wu and colleagues (2023) used Joinpoint models and age-period-cohort analysis (ACPA) to paint a picture of what could be expected. The study notably addressed all mental disorders in a scope that stretches beyond mood disorders, anxiety and fear-related disorders, and stress and trauma-related disorders. Conducted and written at a time when the authors note that Joinpoint software was somewhat new in application to the field, they stringently applied numerous statistical techniques to correct against margins of error and check for validity in their projections. Wu et al.’s findings mirror those of other researchers, with people – especially women – living in affluent nations being affected most (2023). Their findings echo the common trend of younger overall ages of onset, with mental disorders peaking at an average age of 24. The study shows incidences of mental disorders, on average, gently decrease as age increases. Despite a slight rebound at the average age of 39 years of age, mental health concerns generally taper off later in life.
DALYs are markedly higher for men of all ages, indicating that men suffering from mental health disorders are more likely to struggle against the presence of a disorder in daily life (Wu et al., 2023). These increased average DALYs, for men, may be due to the study’s focus on all mental disorders (many of which can be more severe than others), and the inclusion of substance and alcohol use as a mental health disorder, being far more common among men. Men may also be collectively overcoming stigma and seeking mental health care in greater numbers, adding increasing figures of incidence in the most recent years of the dataset examined for the study.
A greater awareness about mental health may have permeated the societies of some nations, encouraging many women to seek mental health care sooner (Wu et al., 2023). Potentially an effect of earlier interventions and cultural awareness regarding good mental health, the incidences of mental disorders for women have declined slightly.
It is notable that in wealthier, affluent nations, while stigma may be lessened and access to care more readily available, the degrees of social stress – and stress in general – may be higher and may correlate to heightened incidences of mental health disorders (Wu et al., 2023). Conversely, in nations with less social hyperconnectivity and less relative overall material wealth, a lower overall burden of stress may contribute to fewer average mental health complaints – despite access to mental health care being lower as well. In affluent nations, the awareness of, access to, and education surrounding mental health care may act as a counterweight to decrease the projected rates in the coming decades. While the sum impacts the stressors an individual experience in terms of their capacity for coping and resilience are unique variables, the implementation of supportive measures at all tiers of societies and across nations may be yielding a positive impact in the battle against each of the global mental health epidemics.
Rational and tenable measures which may decrease the projected prevalences of mental health concerns within any society include the following: early intervention programs, psychological rescue for individuals in disaster areas, governmental investments in overall healthcare infrastructure and education, and the expansion of social supports for individuals and communities.
Notable Psychotherapeutic Modalities
Each of the most common mental health concerns can respond to therapy. Due to the average size of patient populations increasing in affluent nations, the average caseloads of many future clinicians are likely to reflect this growth. If the average demand for therapists who can effectively treat the most common mental health complaints of those populations are considered, some therapeutic modalities will be far more pragmatic, useful, and common. The ethical standard should be evidence-based therapies which focus on best outcomes within safe therapeutic spaces.
While pharmacologic monotherapy is clearly an option for many people who suffer from specific mental health symptoms, it is shown that psychotherapy can be as effective as medications (Cui et al., 2024). When pharmacotherapy and psychotherapy are combined, for some individuals, the best outcomes are achievable. Still other patients might benefit from psychotherapy over shorter periods of time, perhaps several weeks of therapy or counseling, as opposed to months or years (“In Brief,” 2022).
There are dozens of overarching categories of therapeutic modalities, each of which have their own branches – like subgenres of music. Each of these subgenres can have dozens of variations, nuanced approaches, or niche use-case scenarios which can qualify a therapy as a distinct and unique modality. Some modalities have fallen out of favor entirely and have been relegated to history, for all intents and purposes, despite having birthed modern variations of therapies that are alive and well. The overwhelming popularity of psychoanalysis in Argentina, a nation in which having a therapist and attending therapy sessions is fully normalized, is largely sourced from Freudian and Jungian psychoanalytic thinking, yet these widespread forms of psychoanalysis that currently dominate Argentinian therapeutic landscapes are fully modernized (Giovannetti et al., 2022).
The most common psychotherapeutic treatment modalities of the current era are most common for a very simple reason: they treat the most common mental health concerns of the affluent world’s patients most effectively. Prominent modalities include cognitive behavioral therapy (CBT), mindfulness-based therapy (MBT), dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), humanistic therapy, play therapy, group therapy, couples therapy, family therapy, eye movement desensitization and reprocessing (EMDR), family systems therapy, modernized forms of psychoanalysis, and eclectic therapies.
Cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT) is perhaps the most common present-day therapy, having birthed scores of subtypes of therapies which draw from a common cognitive-behavioral framework. CBT prominently focuses on cognitions; cognitions can include thoughts, logic, feelings, perceptions, emotions, and moods (“In Brief,” 2022). In the therapeutic space, CBT largely focuses on identifying the presence of cognitive distortions (e.g. thoughts, worldviews, beliefs, biases) within an individual’s thought processes. Patients in therapy can discover how such distortions in their cognitions can impact their emotions, behaviors, and still other thoughts or views (Beck & Beck, 2011). Clinicians work with patients to identify these distortions; problem-solving and coping strategies are often presented alongside new perspectives or new ways of thinking. ‘Homework’ for patients, assigned by therapists to be completed in real life between appointments, can be an in vivo practice to improve aspects of adaptation, coping, or overall quality of life – working toward better mental health.
CBT is sometimes considered to be the gold standard of the contemporary psychotherapeutic clinical landscape. Some criticisms of CBT surround its origins, being derived from with clinical spaces (as opposed to being empirically derived), integrative aspects, and questions regarding the true nature and definition of cognition, all deserving of further empirical inquest (Fernández-Álvarez & Fernández-Álvarez, 2019). Despite such largely theoretical criticisms, the pragmatic and evidence-based successes of CBT, at present day, remain relatively unchallenged. CBT can be used to treat each of the most common mental health complaints and disorders identified of the contemporary and projected patient populations of wealthier nations; furthermore, CBT may be adapted to effectively address and treat the less common and more severe disorders (Curtiss et al., 2021). These adaptations of CBT can extend to the treatment of eating disorders, non-unipolar mood disorder, OCD, psychoses, personality disorders, and dissociative disorders, readily spanning beyond depressions, anxiety and fear-related disorders, trauma and stress-related disorders, and addictions.
One drawback to CBT is that it can be time-consuming for some patients. Considering that not all patients require months or years of therapy to experience improvements, Brief CBT (BCBT) is a therapeutic modality which can address patients’ problems in shorter amounts of time. Moreover, BCBT has the added benefit of managing a common problem within the clinical space, which is that patients do not attend all of their recommended appointments with therapists. Even when medically recommended, factors like time, money, or disinterest may lead to patients discontinuing therapy. Brief CBT lessens these risks because whereas CBT might feature an average of 12-20 sessions, BCBT sessions could total half as many office visits – or less. BCBT is often associated with assessing and treating substance use, the concerns of military veterans, depression, anxiety, grieving, and individualized problems within a life (Center for Substance Abuse Treatment, 1999). BCBT grows in popularity due to being problem-focused and goal-oriented, making it very appealing to individuals who have a specific concern that they wish to address but are not willing or able to commit to the long-term commitment of regular visits with a therapist.
Mindfulness
Mindfulness-based therapy (MBT) is a branch of therapeutic modalities utilizing mindfulness-based techniques. The techniques often serve to elevate awareness and often involve a variety of meditative practices. While mindfulness can adapt with the individual and be added to other therapies through eclectic approaches, the lines of where mindfulness begins and ends, in a clinical sense, can sometimes blur, and the subtypes of therapies involving mindfulness are vast. Within clinical spaces, for traumas, mindfulness and meditation can be utilized to create calm within the human condition. Such practices are also useful to quell anxieties, fears, and stress. Mindful practices can bridge into group therapies and group work as well as provide a therapeutic framework for individual patients.
Distinct or intensive meditative practices are included in the purview of mindfulness-based therapies, yet do not need to originate from, or occur in, a clinical space. Mindfulness-based therapies can incorporate elements of spiritual practices, like the many variations of Yoga, Taoism, or Buddhism, all of which feature ancient variations of the modern definitions of mindfulness. The benefits of mindfulness can be achieved without therapeutic instruction, as a preventative measure, or as a self-directed early intervention. Mindful movement, for example, can be integrated with exercises (e.g. walking, hiking, swimming); scheduling brief sessions of breathwork can help to cope with the stresses that an individual experiences. Adding lifestyle and health benefits which are self-evident countermeasures against some depressions and anxieties hedges toward better health and quality of life at the level of the individual.
When treating depression with MBCT, for example, a therapist might encourage a patient to feel their negative thoughts and feelings (i.e. the components of their depression) more fully, to embrace those uncomfortable internal experiences with compassion for self, to explore those aspects of self with a new curiosity, to practice patient acceptance, all while en route to diminishing the depression over time (Kaye, 2019). A therapist might encourage a patient to take a less reactive approach to internally distressing thoughts and feelings, while the elements of CBT act to alter and remedy the patient’s cognitive distortions.
Short-form mindfulness-based stress reduction (MBSR) is a therapy that can be conveniently condensed into far fewer office visits. Sometimes conducted in group or seminar settings, a therapist could also encourage a patient to schedule their ‘homework’ of mindful practices outside of office visits and in their own free time. In the busy societies of the affluent world, this kind of flexibility can be highly desirable. Additional prominent mindfulness-based therapies include mindfulness-based cognitive therapy and dialectical behavioral therapy. All of these modalities can be adapted to successfully treat the most common mental health concerns.
Acceptance and Commitment Therapy
Like branches and varieties of MBT or CBT, acceptance and commitment therapy (ACT) shows effectiveness across a range of mental health complaints and can be used to treat each of the most common mental health concerns of the contemporary world (Levin et al., 2024). In ACT, there is an acceptance component that involves helping patients to accept aspects of their life as they are, and a commitment component that serves to fortify a patient’s resolve to overcome their challenges in life. ACT is goal-oriented in how it seeks to align a person’s thoughts, behaviors, and reactions in a way that is more concurrent with a patient’s own ideals and values. A core aim of ACT hinges on increasing the overall psychological flexibility of a patient while focusing on a patient’s ability to embrace and embody what they value in life. ACT, like many prominent therapeutic modalities, is not limited to the treatment of diagnosed disorders and can be used to help individuals with other concerns (e.g. behavioral, social, existential, life scenario) overcome obstacles of any kind in life – toward a betterment of self and overall quality of life.
ACT can appear very similar to humanistic therapy – another overarching branch of therapeutic modalities. Humanistic therapy tends to focus on a patient’s potential and growth, seeks to help a patient become their best self or work toward self-actualization, and highlights the innate capacities of the human condition which are deemed to be inherently good. Both approaches – ACT and humanistic – encourage personal growth from a realistic perspective of a patient’s current reality. Despite how these approaches are differentiated by separate theoretical points of origin (ACT being derived from CBT and humanistic therapy being derived from humanitarian philosophies), their clinical utility is broad and extends beyond mental health diagnoses. Like ACT, humanistic-centered psychotherapies can treat numerous mental health concerns and can be applied to each of the most common mental health concerns.
Play, Group, Family, and Couples Therapies
Play therapy is generally associated with preadolescent children yet can extend to any younger person in the process of growing up into adulthood. Play therapy can help children process and cope with difficult scenarios in their lives, often focusing on self-esteem, difficult emotions, troublesome behaviors, feelings, and difficult life experiences like traumas or loss (The Power of Play, n.d.). Play therapy can be transposed to adolescents and adults and can extend beyond the kinds of role play which might introduce concepts like coping behaviors or healthier ways to handle problems or express communication.
In a sweeping 2024 meta-study that sought to analyze the efficacy and viability of using tabletop role-playing games (TTRPGs) as a tool for interventions and as an emerging therapeutic modality, researchers reported many promising results (Yuliawati et al., 2024). TTRPGs are a social endeavor which can augment group therapies; group therapies are a common modality as these offer fellowship and support among individuals sharing a common problem in their lives. Yuliawati and colleagues found that applications of TTRPGs appear to be growing within the clinical space). While there are many unknowns regarding theoretical frameworks, evidence, or outcomes, the exploratory progress found in new applications of frameworks is an ongoing attempt of innovation which, at the very least, can enliven group therapy sessions, and at the very best, create sustained interest. It would not be surprising for such systems to gain prominence as effective therapeutic modalities in the future.
Couples counseling and family therapy are notable varieties of smaller group therapy which can focus on the concerns of the individuals of these close-knit and more intimately acquainted social groups, as well as the quality and health of social group as a unit. An individual might seek counseling for support and advice when impacted a life event, like the loss of job or financial stability, the experience of an existential moral crisis, the loss of a loved one and grieving, or as a preventative measure before their professional life can induce the disorder of burnout, a couple might have an ongoing impasse of ongoing conflict, and a family might want to heal its rifts. These interpersonal scenarios might occur independently among patients or all at once within the same family. Depending on the patient or group of patients, couples and family therapies seek to create progress in the social interactions and the lives of those involved.
Therapeutic modalities in these scenarios are broad. If one or many patients in group, a couple, or a family suffers from one of the most common mental health complaints, these varieties of therapies can work to improve the lives of those suffering from the mental health concerns, the lives of those who care about and support them, and the quality of life of those involved in a broader overarching sense. Family Systems therapy is a newer approach to family therapies which seeks to consider the varying roles of family members within the family unit. While the theoretical framework is intriguing and may eventually prove to regularly create best outcomes, it is too soon to wager if this burgeoning therapy will grow to become more widespread in the future.
While some therapies have found widespread use in the treatment of specific disorders and can even be considered a best practice in some professional circles, other therapies, such as Eye movement Desensitization and Reprocessing (EMDR), for the treatment of PTSD, encounters some skepticism within the professional communities. Arguments against EMDR often focus on how clinicians cannot prove or disprove the efficacy of the physical components of EMDR sessions beyond those benefits received from regularly attending therapy. Considering the controversy surrounding EMDR, despite the many patients and clinicians who clearly experience favorable outcomes, it is currently difficult to posit if EMDR will or will not be a common therapy in the future. Various treatments for specific phobias, for example, like emersion therapies, are less contentious and well-established. Focusing on results, however, novel evidence-based therapeutic modalities and niche treatments which can effectively treat specific disorders are clearly worthy of consideration.
Discussion
Societal Shifts
Societal shifts are a cultural constant of never-ending flux. Estimates for the future rates of mental illness can address demographics (e.g. gender, age, net worth), yet cannot be expected to include more complex kinds of variables (e.g. individualism, consumerism, degrees of sophistication). Some parallels and correlations can nonetheless be acknowledged.
The most educated and culturally sophisticated affluent nations, like those of Western Europe, Japan, and South Korea, have preceded the United States in suffering a ‘loneliness epidemic’ and population declines. The loneliness epidemics are cultural phenomena correlated with negative population replacement rates: fewer people meet and date, form fewer couples, leading to fewer marriages, and too few children are born to sustain or grow a population. It is self-evident that chronic loneliness also has negative impacts upon mental health of the individual and vice versa.
Like the United States, the nations of the Anglosphere are affluent individualist cultures connected by a common language. Culture flows between these nations easily, as a result. The affluent individualist nations of Western Europe (which primarily speak languages other than English) trail the Anglosphere in rates of some mental health disorders. The affluent individualist cultures of Scandinavia often report higher qualities of life and overall happiness, with strong ‘social safety nets’ in place, decreasing worry and stress; most cases of depressions are thought to be due to the shorter days of their northern winters. Psychotherapy is perceived as a viable treatment for the mental health concerns across these nations. Some Eastern affluent nations (e.g. Japan, South Korea) feature the fewest cultural similarities to the Anglosphere (non-English speaking, non-individualist), yet feature the lowest reported rates of mental health concerns among all affluent nations. Collectivist cultures often have negative stigmas associated with mental unwellness, potentially deterring individuals from seeking professional help.
As more nations grow in material wealth and infrastructure, more populations will become affluent. Individuals living in those newly affluent cultures may be expected to feel the same social pressures and stressors of affluent lifestyles, potentially leading to the mental health concerns commonly seen in such cultures.
Technological Advancement
Telehealth options have become commonplace in the affluent world, with patients using it for everything from initial consultations to follow-up appointments and regular care. Apps can be used for initial assessments, connecting patients to additional resources and letting them know if they should seek the ‘in real life’ care of a human professional. The accuracy of technology-assisted clinical diagnostics can help to remove the element of subjectivity from diagnostic processes while helping to standardize clinical norms across cultures. Biomarker tests for some of the more common mental health diagnoses can help to differentiate between similar disorders and act as a control against the subjectivity of diagnosing professionals. Likewise, the early applications of gene testing may support diagnostics and assist in the creation of treatment plans. Recent advances in artificial intelligence have propelled ever-evolving headlines. As of 2025, some large language models can now mirror the knowledge and skill of many human areas of expertise. In the field of mental health, AI tools used for diagnosis might approach or even surpass the accuracy of human professionals, and in much shorter periods of time.
These advances – telehealth options, apps, biomarker tests, gene testing, and AI – have obvious implications for patients, clinical professionals, and healthcare landscapes. Such advances are rightly considered to be a part of the most seismic of paradigm shifts in history. Nevertheless, despite shifting societal and technological environments, the role of therapists is likely to remain firm over the coming decades. Therapists will continue to provide their expertise across numerous clinical roles on the frontlines of the treatments of the most common mental health concerns.
Conclusion
The most common mental health concerns do not have firm etiologies nor, sadly, do they have known cures. From a global perspective, there is a great burden created by the prevalence of mental health concerns. Depressions, particularly, are expected to become the top contributor to the global burden of disease in the coming decades as the single greatest cause of DALYs. Among affluent nations, the most common mental health concerns are depressions, anxieties, fears, traumas, and stressors. Rates are highest among wealthier adults, wealthier women, women in general, adults with less education, divorced adults, adults with children, and adults who were not employed or attending college. The rates of these concerns are expected to increase somewhat over the coming decades and increase most in nations that are affluent. People younger than 18 years of age suffer some of the earliest AOOs among many mental health disorders and those rates are similarly expected to increase. Adolescent girls are most likely to suffer from certain depressions and anxieties in affluent nations, while adolescent boys are more likely to be depressed and less likely to seek college educations. The presence of comorbidities among the mental health diagnoses, across demographics, is a norm that is not expected to diminish.
Consistent psychotherapy can serve to treat and support individuals with mental health concerns in ways that pharmacotherapies cannot. When paired with medication-based treatments, talk therapies can lead to the best outcomes for patients. There are numerous well-established psychotherapeutic treatment modalities, each capable of successfully treating the most common mental health complaints. Best practices and treatments will naturally evolve over time, improving the efficacies of psychotherapeutic treatment options. The versatility of the most prominent contemporary psychotherapeutic treatments is a reassurance to the strength of psychotherapy as a profession, and its ability to meet the needs of the patients of the future. The foreseeable future shows that therapists will continue to be able to offer their healing role to humanity – to collectively find, achieve, and sustain better lives, to cope with the present and embrace the future within the journey of life itself.
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Neogeneses 