The Prevalence and Correlates of Untreated Serious Mental Illness

Department of Psychology, Cornell University, Итак, New York, United States
Health Services Research (Impact Factor: 2.78). 01/2002; 36(6 Pt 1):987-1007.
Source: PubMed


To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN: The National Comorbidity Survey; cross-sectional, nationally representative household survey.
An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months.
Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own.
Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.

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    • "Long waiting lists before the start of psychological treatment are undesirable, but not uncommon. Patients who are referred to specialized mental health care rarely receive immediate access to psychological treatments [5]. In the Netherlands, for example, the time between registration and the first treatment session is normally at least 6 weeks. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Research has convincingly demonstrated that symptoms of depression can be reduced through guided Internet-based interventions. However, most of those studies recruited people form the general population. There is insufficient evidence for the effectiveness when delivered in routine clinical practice in outpatient clinics. Objective: The objective of this randomized controlled trial was to study patients with a depressive disorder (as defined by the Diagnostic and Statistical Manual of Disorders, fourth edition), as assessed by trained interviewers with the Composite International Diagnostic Interview, who registered for treatment at an outpatient mental health clinic. We aimed to examine the effectiveness of guided Internet-based self-help before starting face-to-face treatment. Methods: We recruited 269 outpatients, aged between 18 and 79 years, from outpatient clinics and randomly allocated them to Internet-based problem solving therapy (n=136), with weekly student support, or to a control condition, who remained on the waitlist with a self-help booklet (control group; n=133). Participants in both conditions were allowed to take up face-to-face treatment at the outpatient clinics afterward. We measured the primary outcome, depressive symptoms, by Center for Epidemiological Studies Depression scale (CES-D). Secondary outcome measures were the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), Insomnia Severity Index questionnaire (ISI), and EuroQol visual analog scale (EQ-5D VAS). All outcomes were assessed by telephone at posttest (8 weeks after baseline). Results: Posttest measures were completed by 184 (68.4%) participants. We found a moderate to large within-group effect size for both the intervention (d=0.75) and the control (d=0.69) group. However, the between-group effect size was very small (d=0.07), and regression analysis on posttreatment CES-D scores revealed no significant differences between the groups (b=1.134, 95% CI -2.495 to 4.763). The per-protocol analysis (≥4 sessions completed) results were also not significant (b=1.154, 95% CI -1.978 to 7.637). Between-group differences were small and not significant for all secondary outcomes. Adherence to the intervention was low. Only 36% (49/136) received an adequate dosage of the intervention (≥4 of 5 sessions). The overall treatment satisfaction was moderate. Conclusions: Internet-based problem solving therapy is not more effective in reducing symptoms of depression than receiving an unguided self-help book during the waitlist period at outpatient mental health clinics. The effect sizes are much smaller than those found in earlier research in the general population, and the low rates of adherence indicate that the acceptability of the intervention at this stage of treatment for depressed outpatients is low. However, taking into account that there is much evidence for the efficacy of Internet-based treatments, it is too early to draw firm conclusions about the effectiveness of these treatments in outpatient clinics as a whole. Trial registration: Netherlands Trial Register NTR2824; (Archived by WebCite at http://www.webcitation/ 6g3WEuiqH).
    Full-text · Article · Mar 2016 · Journal of Medical Internet Research
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    • "Unfortunately, many individuals do not receive adequate treatment for mental health issues such as depression. Even when access to a mental health practitioner is available, many individuals do not seek treatment252627 . This may occur due to the negative stigma surrounding depression and other mental health conditions, for the preservation of privacy concerning personal matters , or because depression may not be perceived as a priority for treatment in individuals suffering from other comorbidities. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Depression is a common comorbidity in individuals with cognitive impairment. Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression, and may have poorer outcomes in areas such as recovery and quality of life. However, the stigmatization of mental health disorders, cost barriers and physical disabilities may prevent these individuals from seeking mental health care. An online, self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population. We aim to inform the design of such an intervention through a systematic review by answering the following research question: among adults with cognitive impairment (including those with acquired brain injuries or neurodegenerative diseases), which technology-amenable interventions have been shown to effectively decrease symptoms of depression? Specifically, psychotherapeutic and/or behavioural interventions that could be delivered in a self-guided, online system will be included. Methods Comprehensive electronic searches will be conducted in MEDLINE, EMBASE, PsycINFO and CINAHL. Additional studies will be obtained through manually searching the references of relevant systematic reviews, contacting primary authors of select articles and tracking conference proceedings and trial registries. Article titles and abstracts will be screened using predefined eligibility criteria, and then judged for their amenability to the proposed self-help, technology-based intervention. The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion. Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-randomized trials, controlled before-after studies and interrupted time series. The primary outcome will be a change in score on a validated depression scale, and adverse events will be documented as a secondary outcome. After data extraction from selected articles, pooling of data and meta-analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified. Alternatively, plain language summaries will be developed. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Systematic review registration PROSPERO CRD42014014417 Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0032-4) contains supplementary material, which is available to authorized users.
    Full-text · Article · Apr 2015 · Systematic Reviews
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    • "Research results have shown that the number of people in need of psychological help is greater than the number of people who actually receive psychological help (Erol, Kılıc, Ulusoy, Kececi, & Simsek, 1998; Kessler et al., 2001). Andrews, Issakidis, and Carter (2001) have put forward that, on an average, less than one-third of the people who will benefit from psychological services actually receive psychological help. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the current research is to identify which factors, and in what direction these factors influence adults’ decisions to seek psychological help for their personal problems. The research was designed as a phenomenology model; the data was gathered through the semi-structured interview technique, which is mostly used in qualitative research designs. In selecting the participants, the criterion sampling technique – one of the purposeful sampling techniques – was used. Two criteria were decided upon in selecting participants; being, never having pursued psychological help previously or having terminated a previous process early. There were 6 male and 4 female participants in the study. The interviews were conducted face to face and recorded by a voice-recorder. The interviews were then examined using descriptive analysis techniques. Two main themes emerged as a result of the analysis; namely, factors that inhibited and factors that facilitated psychological help seeking in adults. Social stigma, unwillingness to share problems with an unfamiliar person, the belief that private problems should be kept in the family, one’s belief that he/she can solve his/her problems, and not knowing enough about the psychological help process were determined as the sub-themes for inhibiting factors. On the other hand, the availability of psychological services, the belief in the benefits of psychological services, trusting in the mental health professional, and receiving help free of cost were determined as the sub-themes for the facilitating factors. The results were discussed in relation to the literature and several suggestions were made regarding how to overcome the barriers preventing individuals from seeking psychological help and how to make facilitative factors more acceptable, so as to increase people’s willingness to seek help.
    Full-text · Article · Feb 2015 · Educational Sciences: Theory and Practice
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