A few months ago, Dr. Ken Duckworth, a psychiatrist in Massachusetts, was swimming in his community's pool, chatting with other swimmers. When he mentioned his profession, one man wanted Duckworth's opinion on his struggles with depression; another asked for advice on a family member's schizophrenia.
"I was sort of amazed. They were talking openly about their psychological vulnerabilities with a stranger in a swimming locker room," said Duckworth, the medical director for the National Alliance on Mental Illness. "That wouldn't have happened 15 years ago."
New research shows that these swimmers aren't the only ones opening up. According to a new study, more American adults than ever are reporting being disabled by the symptoms of depression, anxiety or other emotional problems.
The report, published Thursday in the American Journal of Public Health, found that people who said they couldn't perform everyday tasks or engage in social and leisure activities because of a mental illness increased from 2 percent in 1999 to 2.7 percent in 2009. That increase amounts to nearly 2 million more people disabled by mental distress in the past decade, the report said.
The study analyzed a decade of responses to an annual survey from more than 300,000 adults ages 18 to 64.
Although people did not say they felt more psychologically distressed compared to past years, they reported that their mental health problems had a greater impact on their daily lives.
Dr. Ramin Mojtabai, the study's author, said it's unclear whether the findings tell a sad story of greater psychological distress in recent times or point to a victory for public education about the importance of acknowledging and evaluating mental illness.
"It is possible that people are perceiving the effects of mental illness more acutely now than before," he said. "People could be becoming more aware."
Mojtabai said it's also possible that a number of factors could be taking a toll on the population's mental well-being. High unemployment, economic hardships and a growing sense of isolation could be putting greater stress on Americans.
But Duckworth said there could be a more positive explanation -- like his fellow swimmers, people may be getting more comfortable with talking about their mental distress.
"I wonder if this tells us that American culture is becoming more open and accepting of vulnerability and is giving people the ability to speak about it," he said. "If people have this problem and are willing to acknowledge it, then we're getting closer to addressing it."
People may be more willing to acknowledge their mental troubles, but the study also showed that fewer are seeking treatment for their distress. The number of people who reported seeking help from a psychiatrist, therapist or other mental health care professional went from a low 3.2 percent in 1999 to an even lower 2 percent in 2009. The people who had no contact with mental health services reported the greatest mental health disability.
"It raises the question of access to mental health services," Mojtabai said. "There is clearly an unmet need of mental health care in large section of society."
The number of people who said they couldn't afford to get mental health help from a mental health professional increased during the 10 years of the study.
But experts said an increasing number of people may be turning to their primary care doctors to get treatment for anxiety, depression and other common psychological issues. In 2010, the American Medical Association reported that one-third of patients relied only on their regular physician for help with psychiatric conditions.
Dr. Jim Jirjis, an internal medicine physician at Vanderbilt University, said he treats about one-third of his patients for some sort of mental health problem.
"With the economy being what it is, a lot of patients just don't have the money for yet another co-pay," Jirjis said. "But another reason is they have a trusted, long-term relationship with their primary care doctor, and they may feel safer talking about depression or anxiety with them than going to a stranger to talk about it."
Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University, said this relationship may turn out to be useful because the current study found that patients with chronic health conditions like heart disease or obesity also reported greater mental health disability.
"Primary care settings are where people are regularly seen and cared for by a doctor for lots of things," Williams said. "What's needed is a way to provide them with mental health treatment in those settings."
Many experts agree that this current study shows how much progress has been made in reducing the stigma often attached to struggling with mental health. But many also hope to see much more progress made in making people feel better about getting the mental help they need.
"If people feel they can talk with a survey person over the phone about these issues, I think that shows us that educational and cultural efforts are helping people to feel that these problems are acceptable, and we need to do more of them," Duckworth said.