Treatment-seeking behaviours for depression in the general population: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Journal of Affective Disorders (Impact Factor: 3.38). 06/2009; 121(1-2):59-67. DOI: 10.1016/j.jad.2009.05.009
Source: PubMed


In light of the public health and clinical significance of major depression, treatment utilisation is an important issue. Epidemiological data is particularly useful for yielding accurate estimates of national trends; assessing unmet need in the population; and, informing mental health policy and focused planning of public health prevention and intervention programs.
Based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), latent class analysis (LCA) was used to empirically identify and validate a typology of treatment-seeking behaviours for depression. Analyses were based on a subsample of individuals with a lifetime diagnosis of major depressive disorder (MDD).
A three-class solution emerged as the best-fitting model. The classes were labelled highly active treatment-seeking, partially active treatment-seeking, and inactive treatment-seeking. The classes were validated by reference to predisposing, enabling, and need factors associated with treatment utilisation.
Since information was retrieved by retrospective self-report it was not possible to corroborate information on treatment utilisation or medical conditions with independent clinical or administrative records. Reporting bias and recall error therefore cannot be ruled out. Also, given that the NESARC utilised lay interviewer-administered structured interviews to determine mental health diagnoses, one should be mindful that diagnoses are epidemiological research diagnoses rather than clinician diagnoses.
This study demonstrated the utility of LCA for identifying clinically meaningful subgroups of treatment-seeking behaviour.

Download full-text


Available from: Natacha Carragher,
  • Source
    • "Research in utilization of mental health services shown that greater utilization between females in contrast males. However most of studies on treatment delay consistently failed to find any association between gender and treatment delay in mental disorders[2] Similar most of previous study, we did not find a significant association between gender and delay, that suggested to be related greater perceived stigma attached to male mental health complains and greater PSS for female.[6] However in our study, there was no relationship between stigma and social support with gender and also between stigma and social support with treatment seeking delay. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The different duration of delay to first contact with a psychiatrist in depressive disordered patients has been observed in western and non western cultures. This study aimed to examine the duration and predictive factors of delay in contact with a psychiatrist in depressive patients in Isfahan city of Iran. In This cross sectional study 156 depressive patients were recruited from various outpatient clinics in Isfahan city between January 2013 and February 2013. We used the Anderson Socio-Behavioral Model (ASBM) for examine the role of various factors influencing delay in help seeking. In this models there were three categories variables (predisposing, enabling and need factors). Quintile regression model was used to study the predictors. The median duration between symptom onset and first contact with a psychiatrist was 1 year. In the first step (predisposing model), age at onset of depressive symptoms and never married were negative predictors for delay, but widowed or divorced statues was positive predictors for delay. In the enabling model past contact with health provider was positively associated with duration of delay. In the need model, neither variable had a significant effect on duration of delay. In the full model, younger age at onset, widowed or divorced statues and past contact with health provider increased duration of delay. More delay of help seeking by children and adolescence and probability of maladaptive coping style such as substance use and complicating of situation need to earlier diagnosis of depression in young group and earlier treatment for decrease DALLY for MDD, Therefore we suggest the mental health awareness programs for adolescent in school, and more ever for the influenced roles of parent and other family members and teachers on teen and young person's life, the education for families and teachers on adolescent mental health problems can be effective. First help seeking contact with non-psychiatric medical professionals enhance the delay of contact with a psychiatrist. Appropriate training of non-psychiatric medical professionals and developing a referral system would lead to better provision of mental health care.
    International journal of preventive medicine 03/2014; 5(3):360-4.
  • Source
    • "In our study, the proportion seeking care was 47.1%. Several other studies have showed prevalence for seeking care for psychological distress or a variety of psychiatric diagnoses (such as depression, dysthymia, GAD, panic disorder, phobias), ranging from 36 to 60% [3] [4] [5] [6] [7] [8] [9]. This shows that the problem with people in need who does not seek help is widely spread. "
    [Show abstract] [Hide abstract]
    ABSTRACT: . In primary care, a vast majority of patients affected with depression and anxiety present with somatic symptoms. Detection rate of psychiatric symptoms is low, and knowledge of factors influencing care seeking in persons affected by depressive and anxiety disorders on a population level is limited. Objective . This study aims to describe if persons, affected by depression and anxiety disorders, seek care and which type of care they seek as well as factors associated with care seeking. Method . Data derives from a longitudinal population-based study of mental health conducted in the Stockholm County in 1998–2010 and the present study includes 8387 subjects. Definitions of anxiety and depressive disorders were made according to DSM-IV criteria, including research criteria, using validated diagnostic scales. 2026 persons (24%) fulfilled the criteria for any depressive or anxiety disorder. Results . Forty-seven percent of those affected by depression and/or anxiety had been seeking care for psychological symptoms within the last year. A major finding was that seeking care for psychological symptoms was associated with having treatment for somatic problems. Conclusions . As a general practitioner, it is of great importance to increase awareness of mild mental illness, especially among groups that might be less expected to be affected.
    05/2012; 2012(9):895425. DOI:10.1155/2012/895425
  • Source
    • "While these other studies also examined patients with depression, our sample may not be directly comparable because patients seeking specialty psychiatric services have sociodemographic and clinical differences compared with patients treated in primary care, including higher income, education, and history of suicidality, and better physical health (Gaynes et al., 2008; Simon et al., 2001; Xakellis, 2005). Higher levels of education are associated with treatment seeking for depression after controlling for other factors (Carragher et al., 2010). Therefore, this sample is likely to be somewhat different in alcohol use prevalence and depression severity from either the general population with depression or those patients with depression treated in primary care. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. The sample consisted of 1,183 patients aged 18 and over who completed a self-administered, computerized intake questionnaire and who scored ≥ 10 on the Beck Depression Inventory-II (BDI-II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥ 5 drinks on 1 or more occasions in the past year), alcohol-related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior-year heavy episodic drinking was associated with younger age (p = 0.011), male gender (p = 0.001), and cigarette smoking (p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age (p = 0.008), greater usual quantity of alcohol consumed (p < 0.001), and higher SMAST score (p < 0.001). In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol-related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked.
    Alcoholism Clinical and Experimental Research 04/2011; 35(4):695-702. DOI:10.1111/j.1530-0277.2010.01387.x · 3.21 Impact Factor
Show more