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Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey
  1. Kari A O Tikkinen1,
  2. Jarno Rutanen2,
  3. Allen Frances3,
  4. Brea L Perry4,
  5. Brittany B Dennis5,6,
  6. Arnav Agarwal7,8,
  7. Amna Maqbool9,
  8. Shanil Ebrahim8,10,11,
  9. Janne S Leinonen12,
  10. Teppo L N Järvinen13,
  11. Gordon H Guyatt8,14
  1. 1 Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  2. 2 Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
  3. 3 Department of Psychiatry, Duke University, Durham, North Carolina, USA
  4. 4 Department of Sociology, Indiana University Network Science Institute, Indiana University, Bloomington, Indiana, USA
  5. 5 Department of Medicine, St George’s University of London, London, UK
  6. 6 Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
  7. 7 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  8. 8 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  9. 9 Faculty of Dentistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  10. 10 Systematic Overviews Through Advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  11. 11 Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
  12. 12 Services for Citizens Division, State Treasury, Helsinki, Finland
  13. 13 Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
  14. 14 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Kari A O Tikkinen; kari.tikkinen{at}


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

Design and setting A population-based, mailed survey in Finland.

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

Primary outcome measures 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’.

Results 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.

Conclusions 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.

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

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  • Contributors KAOT, JSL and TLNJ conceptualised the study. KAOT and TLNJ obtained funding. KAOT collected the data. KAOT, JR, AA, AM, SE, JSL and TLNJ participated in the literature review. KAOT, BBD, AA and GHG developed the analysis plan. KAOT, BBD, AA and GHG analysed the data. All the authors contributed to the interpretation of the results. KAOT, JR, AF, BLP, AM and GHG drafted the manuscript. All the authors contributed to the revision, and approved the final version of the manuscript. KAOT is the guarantor.

  • Funding This study was supported by the Competitive Research Funding of the Pirkanmaa Hospital District (grants 9L033 and 9K043), the Academy of Finland (grants 276046 and 309387), the Competitive Research Funding of the Helsinki and Uusimaa Hospital District (grants TYH2016135, TYH2017114, TYH2018120 and TYH2019321), the Jane and Aatos Erkko Foundation, and the Sigrid Jusélius Foundation.

  • Disclaimer The funding sources had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. The authors’ work was independent of the funders.

  • 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.

  • Ethics approval In accordance with the Finnish regulations on questionnaire surveys, the ethics committee of the Pirkanmaa Hospital District in Finland granted exemption from ethical review (R11110).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The raw data of the FIND Survey are available at the Dryad Digital Repository ( (

  • Patient consent for publication Not required.