Barriers to mental health treatment: results from the National Comorbidity Survey Replication

BackgroundThe aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population.MethodRespondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment.ResultsLow perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions.ConclusionsLow perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.

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Barriers to mental health treatment: results from the WHO World Mental Health surveys

Psychological Medicine ◽

10.1017/s0033291713001943 ◽

2013 ◽

Vol 44 (6) ◽

pp. 1303-1317 ◽

Cited By ~ 333

Author(s):

L. H. Andrade ◽

J. Alonso ◽

Z. Mneimneh ◽

J. E. Wells ◽

A. Al-Hamzawi ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Mental Health Treatment ◽

Common Mental Disorders ◽

Structural Barriers ◽

Health Treatment ◽

Need For Treatment ◽

Attitudinal Barriers ◽

Perceived Need ◽

World Mental Health

BackgroundTo examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.MethodData were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 636 78) and analyzed at different levels of clinical severity.ResultsAmong those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).ConclusionsLow perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

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Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Psychological Medicine ◽

10.1017/s0033291712000025 ◽

2012 ◽

Vol 42 (9) ◽

pp. 1997-2010 ◽

Cited By ~ 147

Author(s):

R. C. Kessler ◽

S. Avenevoli ◽

K. A. McLaughlin ◽

J. Greif Green ◽

M. D. Lakoma ◽

...

Keyword(s):

Factor Analysis ◽

Mental Disorders ◽

Common Mental Disorders ◽

Prior History ◽

National Comorbidity Survey Replication ◽

National Comorbidity Survey ◽

Co Morbidity ◽

The Us ◽

Dsm Iv ◽

Subsequent Onset

BackgroundResearch on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).MethodA national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders.ResultsFactor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7–6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1–64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders.ConclusionsAdolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.

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Does Having a Chronic Physical Condition Affect the Likelihood of Treatment Seeking for a Mental Health Problem and Does This Vary by Ethnicity?

The International Journal of Psychiatry in Medicine ◽

10.2190/pm.42.4.f ◽

2011 ◽

Vol 42 (4) ◽

pp. 421-436 ◽

Cited By ~ 3

Author(s):

K. M. Scott ◽

J. Kokaua ◽

J. Baxter

Keyword(s):

Mental Health ◽

New Zealand ◽

Mental Disorders ◽

Physical Condition ◽

Mental Health Treatment ◽

Treatment Seeking ◽

Health Treatment ◽

Physical Conditions ◽

Ethnic Subgroups ◽

Chronic Physical Conditions

Objective: The comorbidity of mental disorders with chronic physical conditions is known to have important clinical consequences, but it is not known whether mental-physical comorbidity influences mental health treatment seeking. This study investigates whether the presence of a chronic physical condition influences the likelihood of seeking treatment for a mental health problem, and whether that varies among ethnic subgroups in New Zealand. Methods: Analyses were based on a subsample ( n = 7,435) of The New Zealand Mental Health Survey, a nationally representative household survey of adults (response rate 73.3%). Ethnic subgroups (Maori and Pacific peoples) were oversampled. DSM-IV mental disorders were measured face-to-face with the Composite International Diagnostic Interview (CIDI 3.0). Ascertainment of chronic physical conditions was via self-report. Results: In the general population, having a chronic medical condition increased the likelihood of seeking mental health treatment from a general practitioner (OR: 1.58), as did having a chronic pain condition (OR: 2.03). Comorbid chronic medical conditions increased the likelihood of seeking mental health treatment most strongly among Pacific peoples (ORs: 2.86–4.23), despite their being less likely (relative to other ethnic groups) to seek mental health treatment in the absence of physical condition comorbidity. Conclusion: In this first investigation of this topic, this study finds that chronic physical condition comorbidity increases the likelihood of seeking treatment for mental health problems. This provides reassurance to clinicians and health service planners that the difficult clinical problem of mental-physical comorbidity is not further compounded by the comorbidity itself constituting a barrier to mental health treatment seeking.

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Mental Health Treatment Histories, Recovery, and Well-being

Society and Mental Health ◽

10.1177/21568693211068879 ◽

2022 ◽

pp. 215686932110688

Author(s):

Peggy A. Thoits

Keyword(s):

Mental Health Treatment ◽

Medical Model ◽

Well Being ◽

Treatment Seeking ◽

Severe Illness ◽

Sociological Research ◽

Health Treatment ◽

Serious Illness ◽

National Comorbidity Survey Replication ◽

New Directions

Epidemiological and sociological research on recovery from mental disorder is based on three rarely tested medical model assumptions: (1) recovery without treatment is the result of less severe illness, (2) treatment predicts recovery, and (3) recovery and well–being do not depend on individuals’ treatment histories. I challenge these assumptions using National Comorbidity Survey-Replication data for individuals with any disorder occurring prior to the current year ( N = 2,305). Results indicated that (1) untreated remissions were fully explained by less serious prior illness, (2) treated individuals were less likely to recover due to more serious illness, and (3) people who had past–only treatment were more likely to recover than the never–treated, while those in recurring and recently initiated care were less likely to recover. Treatment histories predicted greater well–being only if recovery had been attained. Histories of care help to explain recovery rates and suggest new directions for treatment–seeking theory and research.

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Comorbidity and treatment of mental disorders and sleep problems in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Comprehensive Psychiatry ◽

10.1016/j.comppsych.2010.06.015 ◽

2010 ◽

Vol 51 (6) ◽

pp. e1

Author(s):

J. Baller ◽

S. Swanson ◽

S. Avenevoli ◽

M. Burstein ◽

R. Kessler ◽

...

Keyword(s):

Mental Disorders ◽

Sleep Problems ◽

National Comorbidity Survey Replication ◽

National Comorbidity Survey ◽

The Us

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Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R)

Psychological Medicine ◽

10.1017/s0033291709990213 ◽

2009 ◽

Vol 40 (2) ◽

pp. 225-237 ◽

Cited By ~ 265

Author(s):

R. C. Kessler ◽

H. Birnbaum ◽

E. Bromet ◽

I. Hwang ◽

N. Sampson ◽

...

Keyword(s):

Mental Disorders ◽

Old Age ◽

Age Differences ◽

Late Life ◽

The Elderly ◽

National Comorbidity Survey Replication ◽

National Comorbidity Survey ◽

Co Morbidity ◽

Physical Disorders ◽

Dsm Iv

BackgroundAlthough depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.MethodWe studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.ResultsLifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged ⩾65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.ConclusionsGiven that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.

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