Psychiatric Disorder Onset and First Treatment Contact in the United States and Ontario

Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 11/1998; 155(10):1415-22. DOI: 10.1176/ajp.155.10.1415
Source: PubMed
The authors describe the timing of the first treatment contact following new-onset DSM-III-R mood, anxiety, and addictive disorders in community samples from the United States and Ontario, Canada, before and after passage of the Ontario Health Insurance Plan.
The authors drew data from the National Comorbidity Survey (NCS) (N=8,098) and the mental health supplement to the Ontario Health Survey (OHS) (N= 9,953). They assessed psychiatric disorders with a modified version of the Composite International Diagnostic Interview; they also assessed retrospectively age at disorder onset and first treatment contact. They used the Kaplan-Meier method to generate time-to-treatment curves and survival analysis to compare time-to-treatment intervals across the two surveys.
The overall time-to-treatment curves revealed substantial differences between disorders that were consistent across the two surveys. In both surveys, panic disorder had the highest probability of first-year treatment (NCS, 65.6%; OHS supplement, 52.6%), while phobia (NCS, 12.0%; OHS supplement: 6.5%) and addictive disorders (NCS, 6.4%; OHS supplement, 4.2%) had the lowest in both surveys. Retrospective subgroup analysis suggests that before the passage of the Ontario public insurance plan, the likelihood of receiving treatment in the year of disorder onset was greater in Ontario than in the United States but that this relationship reversed following passage of the Ontario plan. During this period, the authors observed no significant between-country differences in the probability of prompt treatment of adults with 12 or fewer years of education.
These results challenge the assumption that the universal health insurance plan in Ontario promotes greater access to mental health services than is available in the United States for vulnerable groups. Marked differences between disorders in the speed to first treatment suggest that in both countries, clinical factors play an important role in the timing of the initial decision to seek treatment.

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    • "The distribution of the delay in seeking treatment after first lifetime depression onset in our study formed a Jshaped curve pattern: a distribution where the probability of initial treatment contact is the highest in the first year of symptom onset, and gradually decrease with subsequent years. This distribution pattern of delay in seeking initial treatment for depression is consistent with the epidemiological studies conducted across na- tions [31,41,42]. The median DUI was 4 months in our sample. "
    [Show abstract] [Hide abstract] ABSTRACT: A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample. Ninety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed. Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th-75th percentile, 2-13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance. Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.
    Full-text · Article · Dec 2014 · International Journal of Mental Health Systems
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    • "There have been a number of suggested explanations for the high level of unmet need in Australia but, to date, no consistent features have been found to accurately explain its cause (Barney, Griffiths, Jorm, & Christensen, 2006; Green, Hunt, & Stain, 2012; Komiti, Judd, & Jackson, 2006; Olfson, Kessler, Berglund, & Lin, 1998; Thompson, Hunt, & Issakidis, 2004). Despite this, several government initiatives have been created in an attempt to deal with the problem; however, at present , the population of unmet need appears not to have been significantly reduced—rather, it appears to have grown (Andrews, Titov, & Schwencke, 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this paper was to analyse the effectiveness of computer-based interventions for anxiety-based disorders in Australia and to propose an alternative model for computer-based interventions through the focus of neuropsychotherapy. In order to illustrate the importance of this subject, the first chapter identified that not only does the number of Australians who have an anxiety-based disorder appear to be growing; only 37.8% of the Australians who have an anxiety-based disorder are actually seeking treatment. There is a large population of unmet need in the Australian community and that there is a demand for alternative treatment options that may address this unmet need. The second chapter identified that there is a significant economic impact for both the individual suffering from an anxiety-based disorder and the Australian community as a whole. As a result, this chapter suggests that there is both an ethical and financial incentive for the government to address the large population of unmet need in Australia. The third chapter suggests that the inclusion of Internet-based anxiety disorder treatment programs may potentially meet some of the unmet need in the Australian community. Consequently this chapter conducted a critical review of this literature and identified that human-supported web-based therapeutic interventions have been shown to have the capacity to be just as effective as traditional face-to-face psychotherapy with similar levels of client dropout and adherence rates. The fourth chapter identifies that the recent developments in neuropsychotherapy have improved mental healthcare and thus discusses how the principles of neuropsychotherapy are applied to the treatment of anxiety disorders in general. Chapter five specifies how Internet-based treatments and are conceptualized through neuroscience and neuropsychotherapy. Consequently, chapter six concludes this critical review by proposing an alternative web-based therapeutic intervention model based particularly on the analysis set out in Chapters four and five. This alternative model suggests that the human-supported web-based treatment include occasional traditional face-to-face interaction between the client and the therapist such that the web-based therapeutic session would not act as a stand-alone service but actually serve as a complimentary intervention combined with traditional face-to-face therapy.
    Full-text · Article · Oct 2014
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    • "That is rather low, compared not only with countries where GPs undertake a major role for mental health service delivery (Gormley and O'Leary, 1998; Steel et al., 2006 ), but also with countries where mental health specialists is directly responsible for providing the service (Fujisawa et al., 2008). In parallel with the above patients' sample studies, previous community based-studies also reported approximately 50% to 70% people with depression from developed countries (Angst and Merikangas, 1997; Olfson et al., 1998; Galbaud du Fort et al., 1999; Christiana et al., 2000) sought timely depression treatment. In all, the results suggest a relative underutilization of mental health services among the Korean population. "
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    Full-text · Article · Aug 2014 · Asia-Pacific Psychiatry
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