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BMJ Open. 2019 Jun 4;9(6):e024265. doi: 10.1136/bmjopen-2018-024265.

Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey.

Author information

Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.
Department of Psychiatry, Duke University, Durham, North Carolina, USA.
Department of Sociology, Indiana University Network Science Institute, Indiana University, Bloomington, Indiana, USA.
Department of Medicine, St George's University of London, London, UK.
Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Faculty of Dentistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Systematic Overviews Through Advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.
Services for Citizens Division, State Treasury, Helsinki, Finland.
Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.



To assess which mental health-related states of being are perceived as diseases by psychiatrists, non-psychiatric physicians, nurses, parliament members and laypeople.


A population-based, mailed survey in Finland.


Respondents from a random sample of 3000 laypeople, 1500 physicians, 1500 nurses and all 200 members of the parliament (MPs) of Finland.


Respondents' perspectives on 20 mental health-related states of being as diseases, measuring the extent of agreement with the claim: '[This state of being] is a disease'.


Of the 6200 people approached, we received 3259 eligible responses (53%). Two conditions (schizophrenia and autism) were considered to be diseases by at least 75% and two states (grief and homosexuality) were considered not to be diseases by at least 75% in each group. A majority (at least 50% in each group) considered seven states as diseases (anorexia, attention deficit hyperactivity disorder, bulimia, depression, generalised anxiety disorder, panic disorder and personality disorder) and three not to be diseases (absence of sexual desire, premature ejaculation and transsexualism). In six states, there was a wide divergence of opinion (alcoholism, drug addiction, gambling addiction, insomnia, social anxiety disorder and work exhaustion). Psychiatrists were significantly more inclined to considering states of being as diseases relative to other groups, followed by non-psychiatric physicians, nurses, MPs and laypeople.


Respondents agreed that some conditions, such as schizophrenia and autism, are diseases and other states, such as grief and homosexuality, are not; for others, there was considerable disagreement. Psychiatrists are more inclined to consider mental health-related states of being as diseases compared with other physicians, who, in turn, are more inclined than other constituencies. Understanding notions of disease may underlie important debates in public policy and practice in areas of mental health and behaviour, and have implications for resource allocation and stigma.


Diagnostic and Statistical Manual of Mental Disorders; International Classification of Diseases; diagnosis; disease definition; mental disorders; psychiatry

Conflict of interest statement

Competing interests: JSL practices insurance medicine and is the chief medical officer at Services for Citizens Division, State Treasury, Finland. SE is employed by Deloitte LLP. KAOT, JR, AF, BLP, BBD, AA, AM, TLNJ and GHG declare no conflicts of interest.

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