Before the 1990s, little was known about the prevalence of mental health conditions in England.
The data simply didn’t exist, especially in relation to undiagnosed or untreated conditions.
To address this gap, the (then) Department of Health commissioned social researchers, psychiatrists and epidemiologists to design a survey to rigorously assess mental illness in a random sample of the general population. It was catchily named the Adult Psychiatric Morbidity Survey (APMS), though in field it goes by the more user-friendly moniker of the ‘National Study of Health and Wellbeing’.
The interview included a new schedule based on the way in which a mental health assessment would be done in a clinical setting, but designed for administration by lay interviewers. Participants screening positive were followed up with a second phase interview, conducted by interviewers with specialist training able to use judgement to assess disorders such as psychosis and autism.
Soon after the first survey launched Howard Meltzer - with colleagues at the Office for National Statistics, University of Leicester, and elsewhere - set-up mental health surveys of other populations too, including offenders, the homeless, and people living in institutions. Those surveys have never been repeated, despite changes in these populations and an urgent need to understand their current mental health and circumstances.
The general population surveys of adults, however, have been conducted every seven (or so) years: 1993, 2000, 2007, 2014. In 2014, for example, National Centre for Social Research (NatCen) interviewers went into the homes of a random sample of 7,500 people aged from 16 to over a hundred, including some with no contact with health services and many with conditions that hadn’t previously been identified. Development work is currently underway, carried out by NatCen and the University of Leicester, for a 2022 survey: making APMS the longest-running series in the world to monitor changes in a nation’s mental health and related behaviours using consistent methods.
Using the data
With permission from NHS Digital (now the survey commissioner and lead, with funding from the Department for Health and Social Care), datasets from the series are freely available to researchers through the UK Data Service’s archive. Over the years, academics, clinicians, epidemiologists, policy makers, campaigners, and others have collaborated on more than 400 reports and papers.
Alongside assessing mental disorder using screening tools and assessments, the APMS questionnaire collects data on the wider circumstances of people’s lives. Many of the publications provide evidence on inequalities in mental health by a range of demographic, social and economic factors, including:
Mental health in an unequal world
The theme of World Mental Health Day this year was mental health in an unequal world. The data from APMS are uniquely well placed to explore this. Not only in relation to prevalence of and temporal trends in mental health conditions, but also in terms of who gets treatment and support. Looking at health service data on its own can’t tell us about inequalities in treatment access. The latest APMS report revealed, for example, that black people with a common mental disorder are far less likely than white British people to get treatment.
The 2007 APMS was one of the first government-funded surveys to ask about sexual identity and the first to combine data on this with assessments of mental illness. Analyses of the data showed that being lesbian, gay or bisexual (defined by both identity and sexual partnership) was associated with depression, generalised anxiety disorder, obsessive compulsive disorder, phobic disorder, probable psychosis, suicidal thoughts and acts, self-harm, and alcohol and drug dependence. Being discriminated against on the grounds of sexual identity was also found to be linked to mental illness, suggesting that discrimination acts as a social stressor contributing to mental health problems in this population. More recent analyses have found no narrowing of these inequalities.
The next survey
The report for the most recent survey set out the methods and described trends and prevalence of disorders, treatment rates, and some associations. The 2022 survey is now in development. We recently conducted a consultation on priorities for content. It will again be a two-phase survey with most content similar to before, so that changes over time can be examined, but will also include new modules on eating disorders, problem gambling and questions about gender identity. The intention is for the survey to remain face to face, but other options are being considered in case of COVID-19 restrictions. Consultation participants expressed strong support for oversampling key groups, such as people from minority ethnic backgrounds or those living in deprived neighbourhoods. If such boosts were to go ahead it should help the next dataset, available in about 2024, be even more valuable for analysts and policy makers addressing mental health inequalities. The next dataset will also contribute to the evidence base on the longer-term impact of the pandemic on population mental health.
Facts about the survey
Date collected: 1993, 2000, 2007, 2014, 2022
Number of participants: ~8,000 per survey
Number of questions: ~3,000
Topics: mental health, treatment and service use, social and economic context
Survey reports: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey
Other publications: https://mentalhealthsurveys.org/
Access to 2014 dataset: https://digital.nhs.uk/services/data-access-request-service-dars
Access to earlier datasets: https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=2000044
Sarah Morris, National Centre for Social Research
Sarah is a Research Director at NatCen Social Research and is overseeing delivery of the APMS at NatCen. She is an experienced health researcher specialising in delivering large-scale social surveys with particular expertise in bio-social data.
Professor Terry Brugha, University of Leicester
Terry is a practicing psychiatrist and epidemiologist who has conducted research on the determinants and prevention of depression and common mental disorders. Having been unusually fortunate to receive training in the 1980s in adult autism recognition and to work in government as a policy adviser in the 1990s, Terry helped initiate APMS, the world’s first (and still only) continuous programme of epidemiological general population case finding studies on adult autism.
Sally McManus, National Centre for Social Research and City University
Sally managed the 2007 and 2014 APMS and advises on the development of the 2022 survey. She’s worked extensively with data from the series, and is a Senior Lecturer in the Violence and Society Centre at City,University of London.
A version of this blog first appeared on the Mental Health Foundation website.