Article

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
ABSTRACT
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. "
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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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