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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    • "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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    ABSTRACT: Introduction: Delays in mental health service utilization for patients with depression have been observed globally. To elucidate some aspects of delays, age-related associations with a series of variables representing different stages of mental health service use were studied concurrently. Methods: A total of 1,433 patients with depression participated in a nationwide Korean Depressive Patient Survey through the collaboration of 70 psychiatric clinics and hospitals. Using logistic and Poisson regression, we investigated whether there is variation in the associations by age. Results: Patients with depression in South Korea spent 3.4 years on average before starting a first depression treatment after the onset of depression, and 58% of them entered depression treatment in the first year of onset. Early onset appeared to lower the chance of "early depression treatment": e.g., adjusted odds ratio (OR)s for onset age of 40-54, 25-39 and <25 versus ≥55 were 0.65 (95% CI = 0.44, 0.94), 0.36 (95% CI = 0.16, 0.81) and 0.18 (95% CI = 0.06, 0.48), respectively. In contrast, favorable associations of early onset with "self-recognition as depression" and "number of nonpsychiatric clinics attended" before visiting psychiatrist were found. Younger cohorts were associated with more positive attitudes toward all mental health utilization measures. Discussion: Delays in depression treatment are lengthy in South Korea. Those with early onset are more likely to have delayed depression treatment but are more willing to seek help from a psychiatrist once they sought for the treatment.
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    • "While several trials have shown that treatments such as pharmacotherapy, psychological interventions, and self-help programs are effective, the treatment gap remains pervasive in most industrialized countries. The proportion of individuals who actually receive treatment in the specialized mental health care system or in the general health care system is low (13), and initial intervention after onset is frequently delayed for many years (14). In the US, approximately 67% of the persons suffering from mental disorders are not treated (15). "
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    ABSTRACT: Mental disorders are common in almost all industrialized countries and many emerging economies. While several trials have shown that effective treatments exist for mental disorders, such as pharmacotherapy, psychological interventions, and self-help programs, the treatment gap in mental health care remains pervasive. Unrestricted access to adequate medical care for people with mental disorders will be one of the pressing public mental health tasks in the near future. In addition, scarcity of financial resources across the public mental health sector is a powerful argument for investigating innovative alternatives of delivering mental health care. Thus, one challenge that arises in modern mental health care is the development of innovative treatment concepts. One possibility for improving mental health care services is to deliver them via the Internet. Online-based mental health services have the potential to address the unmet need for mental health care.
    Full-text · Article · Jun 2014 · Frontiers in Public Health
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    • "A greater understanding of these factors may help inform service planning and help identify modifiable barriers to treatment access. Based on prior work (Blanco et al., 2007) we hypothesized that the cumulative rates of treatmentseeking would be less than 50% and that an earlier age of disorder onset (Kessler et al., 1998; Olfson et al., 1998; Wang et al., 2004), male sex, and minority racial/ethnic ancestry (Adamson et al., 2003; Alegria et al., 2002) would predict longer delays to first-treatment contact. "
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