Adult Psychiatric Morbidity Survey 2023/4

About the study

The Adult Psychiatric Morbidity Survey (APMS) series provides data on the prevalence of both treated and untreated psychiatric disorder in the English adult population (aged 16 and over). This survey is the fifth in a series and was conducted by the National Centre for Social Research (NatCen), in collaboration with the University of Leicester and City St George's, University of London, for NHS England. 

Key findings

This survey screened for a range of mental health conditions, including common mental health conditions (using the CIS-R), attention deficit hyperactivity disorder (ADHD, ASRS), posttraumatic stress disorder (PTSD, PLC-C), signs of dependence on drugs and alcohol (AUDIT), gambling harms (PGSI), personality disorder (SAPAS, SCID-II Q) and bipolar disorder (MDQ). Clinical examinations assessed autism (ADOS), psychotic disorders (SCAN) and eating disorders (SCAN ED). See the report for further details on each condition or health behaviour and how it was examined.

Increased prevalence across a range of indicators of poor mental health  

• The proportion of 16 to 64 year olds, identified with a common mental health condition, increased from 17.6% in 2007 and 18.9% in 2014, to 22.6% in 2023/4. The proportion was higher in women than men at each point.  
• Lifetime non-suicidal self-harm was reported by 3.8% of 16 to 74 year olds in 2007, rising to 6.4% in 2014 and 10.3% in 2023/4.  
• Similarly, the proportion of adults screening positive for ADHD rose from 8.2% in 2007 and 9.7% in 2014, to 13.9% in 2023/4.  

Stability in prevalence evident for other mental health conditions  

• Autism (examined using ADOS) has remained stable in prevalence since 2007, at about one in a hundred adults (0.8%).
• Psychotic disorder (examined using SCAN) also remained stable since 2007, identified in less than one in a hundred adults (0.5%).
• One in fifty adults screened positive for bipolar disorder in both 2014 and 2023/4 (using the MDQ).
• Similar stability over time was evident for personality disorders (using both the SCID-II Q and SAPAS).

Young adults remain a key group  

• The proportion of young adults (aged 16 to 24), with a common mental health condition, rose from 17.5% in 2007 to 25.8% in 2023/4.
• Younger adults were also more likely to report lifetime non-suicidal self-harm and to screen positive for PTSD and ADHD than older age groups.
• There was a decline in drinking at hazardous levels or above. It halved among 16 to 24 year olds (from 40.7% in 2000 to 18.1% in 2023/4) and also fell among those aged 25 to 34 and 35 to 44.

Hazardous drinking declined, while the proportion reporting signs of drug dependence rose  

• Drinking at hazardous levels or above fell from 26.1% of 16 to 74 year olds in 2000 to 18.9% in 2023/4.  
• Signs of dependence on illicit drugs increased from 3.8% of 16 to 64 year olds in 2014 to 6.7% in 2023/4, mostly related to increases in signs of dependence on cannabis.  
• 1.6% of adults experienced at least moderate risk gambling (PGSI score of 3+) and 0.4% of adults experienced problem gambling (as indicated by a PGSI score of 8+).  

Socioeconomic inequalities in mental health persist  

• Adults living in the most deprived fifth of areas, with problem debt and those not in employment were more likely to have most of the mental health conditions covered on the survey, including common mental health conditions and less common conditions such as bipolar and psychotic disorders.  

Physical and mental health were strongly related  

• People with a doctor diagnosed physical health condition that limited their activities, were more likely to have most of the mental health conditions covered on the survey, as well as to report non-suicidal self-harm, suicidal thoughts and suicide attempts, signs of drug dependence and experience at least moderate risk gambling.  

Treatment use for common mental health conditions increased in prevalence  

• The proportion of 16 to 74 year olds, with common mental health condition symptoms (CIS-R 12+), reporting receipt of treatment rose from 24.4% in 2007 and 39.4% in 2014, to 47.7% in 2023/4.
• Receipt of psychological therapies, among those with symptoms (CIS-R 12+), rose from 10.4% in 2007 to 17.9% in 2023/4; and receipt of medication rose from 19.6% in 2007 to 38.4% in 2023/4.

Some adults may be missed by treatment and services  

• Most adults with signs of dependence on alcohol or drugs or experiencing moderate risk gambling had never received treatment related specifically to their drinking, drug use or gambling, and most had not received a related professional diagnosis.  
• Few adults had an autism diagnosis (3.4% of adults thought they were autistic and 1.2% reported this had been diagnosed by a professional), and autistic adults were no more likely to use health services or receive mental health treatment than the rest of the population. 

Methodology

Fieldwork was carried out between March 2023 and July 2024. As with the preceding surveys, a two-phase approach was used for the assessment of several disorders.

6,912 phase one interviews were carried out by interviewers from the National Centre for Social Research and included structured assessments and screening instruments for mental health conditions and disorders as well as questions covering demographics, general health, service use and risk factors.

880 phase two interviews were carried out by clinically trained research interviewers employed by the University of Leicester. A sub-sample of phase one participants were invited to take part in the second phase assessment, which included assessment of psychosis, autism and eating disorders. The assessment of these conditions requires a more detailed and flexible interview than was possible at the first phase, and the use of clinical judgement in establishing a diagnosis.

APMS 2023/4 data was mostly collected through face-to-face interviewer visits. In 2023/4, an option for remote interviews for phase one was available if required.