Original Paper

Administration and Policy in Mental Health and Mental Health Services Research

, Volume 33, Issue 6, pp 666-673

First online:

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

  • Risë B. GoldsteinAffiliated withDivision of Clinical-Genetic Epidemiology, Department of Psychiatry, College of Physicians and Surgeons of Columbia UniversityDivision of Clinical-Genetic Epidemiology, New York State Psychiatric InstituteLaboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism Email author 
  • , Mark OlfsonAffiliated withDivision of Clinical-Genetic Epidemiology, Department of Psychiatry, College of Physicians and Surgeons of Columbia UniversityDivision of Clinical-Genetic Epidemiology, New York State Psychiatric Institute
  • , Elaine Goff MartensAffiliated withDivision of Clinical-Genetic Epidemiology, New York State Psychiatric InstituteDepartment of Neuroscience, University of Connecticut Health Science Center
  • , Susan I. WolkAffiliated withDivision of Clinical-Genetic Epidemiology, Department of Psychiatry, College of Physicians and Surgeons of Columbia UniversityDivision of Clinical-Genetic Epidemiology, New York State Psychiatric Institute

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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.

Keywords

Depressive disorder Substance-related disorders Mental health services Utilization Unmet need