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Subjective Unmet Need for Mental Health Services in Depressed Children Grown Up

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Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Background

Limited attention has been devoted to characterizing unmet need for treatment among individuals with mental disorders. A longitudinal follow-up of depressed, anxious, and psychiatrically normal children into adulthood provided an opportunity to examine factors associated with subjective unmet need.

Methods

Respondents (n = 208) comprise a subsample of a cohort ascertained between 1977 and 1985 consisting of three subgroups: one with major depressive disorder (MDD), one with anxiety disorders but no MDD, and controls with no psychiatric disorder up to ascertainment. Psychiatric status was reassessed in adulthood using the SADS-LA by interviewers blind to childhood diagnoses. Best-estimate diagnoses describing participants’ lifetime clinical course were formulated by senior clinicians. Participants who completed SADS-LA interviews about themselves were invited to complete an additional interview about experiences with health care, including subjective unmet need for and barriers to mental health treatment.

Results

About 37% of respondents reported lifetime histories of subjective unmet need for mental health services. Unmet need was associated with female gender and lifetime mood and substance dependence disorders. The most commonly cited barriers included attitudes toward treatment, not knowing where to obtain it, and financial concerns.

Conclusions

Subjective unmet need was common in this sample. Approaches to reducing it might include public health initiatives to foster more favorable attitudes toward treatment, increase knowledge of where to obtain it, and lower financial barriers.

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Acknowledgements

This work was supported by an Aaron Diamond Foundation Postdoctoral Research Fellowship to Dr. Goldstein at Columbia University and by National Institute of Mental Health Grant #R01-MH50666 and a Senior Investigator Award from the National Alliance for Research on Schizophrenia and Depression to Myrna M. Weissman, Ph.D. The authors express their appreciation to Dr. Weissman for her invaluable guidance on the conceptualization of this study and her comments on drafts of this article.

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Authors and Affiliations

  1. Division of Clinical-Genetic Epidemiology, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA

    Risë B. Goldstein, Mark Olfson & Susan I. Wolk

  2. Division of Clinical-Genetic Epidemiology, New York State Psychiatric Institute, New York, NY, USA

    Risë B. Goldstein, Mark Olfson, Elaine Goff Martens & Susan I. Wolk

  3. Department of Neuroscience, University of Connecticut Health Science Center, Farmington, CT, USA

    Elaine Goff Martens

  4. Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Ln., Rm. 3068, M.S. 9304, Bethesda, MD, 20892-9304, USA

    Risë B. Goldstein

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  1. Risë B. Goldstein
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  2. Mark Olfson
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  3. Elaine Goff Martens
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  4. Susan I. Wolk
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Correspondence to Risë B. Goldstein.

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Goldstein, R.B., Olfson, M., Martens, E.G. et al. Subjective Unmet Need for Mental Health Services in Depressed Children Grown Up. Adm Policy Ment Health 33, 666–673 (2006). https://doi.org/10.1007/s10488-006-0082-y

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