BACKGROUND: Psychiatrization may contribute to the deterioration of public mental health observed in recent decades. The cultural aspects of psychiatrization can be understood as a form of concept creep (progressive expansion) of mental health terminology. Over time, concepts of psychopathology have expanded to encompass a broader range of human experiences, potentially diluting their meaning. Accordingly, previous research has shown a gradual decline in the semantic severity of the word trauma. However, the semantic severity of anxiety and depression has been increasing over time. OBJECTIVE: This study aims to replicate and explain the increases in semantic severity of anxiety and depression by distinguishing between disorder constructs (clinical terms) and lay emotional constructs (everyday emotional terms) and assessing how their semantic severity changes over time. Additionally, we investigate whether mental health discourse and the broader context in which these terms appear influence these changes. METHODS: We analyzed the semantic severity of anxiety, depression, and trauma using leading paragraphs from 4.7 million New York Times articles (1970-2023). We extended this analysis to broader disorder constructs (both generic terms, such as mental illness, and specific terms, such as schizophrenia) and lay emotional constructs (eg, sad and worried). A word2vec model was used to estimate the degree to which these terms appeared in mental health-related contexts, and a Mental Health Index was developed to quantify shifts in discourse. Regression analyses were conducted to assess whether changes in semantic severity were influenced by time and context. RESULTS: The semantic severity of depression increased significantly (τ=0.35; P<.001), while anxiety (τ=0.08; P=.42) and trauma (τ=0.10; P=.33) showed no significant change. However, when controlling for context, severity was consistently higher in mental health-related contexts, and the effect of time became nonsignificant. For specific mental disorder constructs (eg, schizophrenia), semantic severity decreased over time, whereas generic disorder terms (eg, mental illness) remained stable. Lay emotional constructs became increasingly associated with mental health discourse but showed no clear severity trend. CONCLUSIONS: The increasing semantic severity of depression appears to be driven by its growing presence in mental health discourse rather than an inherent shift in meaning. The declining severity of specific, but not generic disorder constructs suggests that the overall representation of mental disorders remains severe, despite its expansion to less serious experiences. Meanwhile, ordinary emotions such as sadness and fear are increasingly discussed in mental health contexts. These trends highlight the evolving cultural framing of mental health and suggest that psychiatrization is shaping public perceptions of emotional experiences.

Department of Psychiatry Faculty of Medicine in Pilsen Charles University Alej Svobody 76 Pilsen 323 00 Czech Republic 420 797727175

Interdisciplinary School of Doctoral Studies University of Bucharest Bucharest Romania

Laboratory of Cognitive Clinical Sciences University of Bucharest Bucharest Romania

MINDCARE FOR ALL Association Bucharest Romania

National Institute of Mental Health Klecany Czech Republic

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