Administration and Policy in Mental Health and Mental Health Services Research

, Volume 33, Issue 6, pp 666–673

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

Authors

    • Division of Clinical-Genetic Epidemiology, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University
    • Division of Clinical-Genetic EpidemiologyNew York State Psychiatric Institute
    • Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological ResearchNational Institute on Alcohol Abuse and Alcoholism
  • Mark Olfson
    • Division of Clinical-Genetic Epidemiology, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University
    • Division of Clinical-Genetic EpidemiologyNew York State Psychiatric Institute
  • Elaine Goff Martens
    • Division of Clinical-Genetic EpidemiologyNew York State Psychiatric Institute
    • Department of NeuroscienceUniversity of Connecticut Health Science Center
  • Susan I. Wolk
    • Division of Clinical-Genetic Epidemiology, Department of PsychiatryCollege of Physicians and Surgeons of Columbia University
    • Division of Clinical-Genetic EpidemiologyNew York State Psychiatric Institute
Original Paper

DOI: 10.1007/s10488-006-0082-y

Cite this article as:
Goldstein, R.B., Olfson, M., Martens, E.G. et al. Adm Policy Ment Health (2006) 33: 666. doi:10.1007/s10488-006-0082-y

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 disorderSubstance-related disordersMental health servicesUtilizationUnmet need

Copyright information

© Springer Science+Business Media, Inc. 2006