Revolving Door mh
Key Points
Rationale
Therapists have long observed the “revolving door” of mental health services, where individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life (Iverach et al., 2014).
This phenomenon suggests that people who have had one disorder are likely to present with symptoms of multiple disorders across their lifespan, spurring explanations like dimensional approaches to mental illness, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) model (Kotov et al., 2017).
However, this observation has not been empirically tested through a meta-analysis.
Method
Themeta-analysis followed PRISMA guidelines and searched MEDLINE, PsycINFO, and Web of Science databases using terms like “lifetime disorders,” “mental health,” and “psychopathology.”
Inclusion criteria were: reporting numbers of current and past mental health diagnoses, adult participants, use of DSM-IV or later diagnostic criteria, and English language.
Search strategy and terms
The initial search yielded 5817 articles, with 1401 duplicates removed. In Step 1, four authors independently screened titles and abstracts of 4416 studies. In Step 2, two authors independently screened the full text of 1245 manuscripts, with almost perfect inter-rater reliability (κ = 0.87).
This process resulted in 38 studies included in the review, with 27 having sufficient quantitative data for meta-analysis.
Inclusion and exclusion criteria
Studies were included if they reported numbers of current and past mental health diagnoses in adults, used DSM-IV or later diagnostic criteria, and were published in English after 1994.
Reviews, case studies, dissertations, abstracts, and conference presentations were excluded.
Statistical measures
Comprehensive Meta-Analysis Version 3 was used for statistical analyses. A random-effects model was used due to significant heterogeneity across studies (Q35 = 772.17, p < .0001, I2 = 95.47).
Subgroup analyses and meta-regressions explored the impact of sample characteristics and diagnostic tools on the relationship between current and lifetime disorders.
Results
Insight
This meta-analysis provides the first empirical evidence for the “revolving door” phenomenon, suggesting that individuals are likely to experience multiple different mental health conditions across their lifespan.
While treatment appears to partially reduce the likelihood of future disorders developing, it does not entirely prevent this risk.
The study also offers insights into common temporal sequences of disorders, with anxiety disorders often preceding mood and substance use disorders.
Strengths
Limitations
Clinical Implications
The results of this meta-analysis have significant implications for clinical psychology practice.
They underscore the importance of transdiagnostic treatments targeting overlapping constructs common to numerous disorders, consistent with recommendations from dimensional approaches like HiTOP
Increasing the accessibility of psychological treatments through stepped care models, such as offering online self-help interventions for mild to moderate symptoms, may be crucial to meet the growing demand for mental health services.
A greater emphasis on relapse prevention, not only for the individual’s current disorder but also for future disorders, should be a priority in treatment. Scheduling follow-up appointments or encouraging the use of smart technologies for symptom self-monitoring post-treatment may prove beneficial.
References
Primary reference
Menzies, R. E., Richmond, B., Sharpe, L., Skeggs, A., Liu, J., & Coutts-Bain, D. (2024). The ‘revolving door’ of mental illness: A meta-analysis and systematic review of current versus lifetime rates of psychological disorders. BritishJournal of Clinical Psychology, 63, 178–196.https://doi.org/10.1111/bjc.12453
Iverach, L., Menzies, R. G., & Menzies, R. E. (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct.Clinical Psychology Review, 34,580–593.https://doi.org/10.1016/j.cpr.2014.09.002
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
