, Volume 15, Issue 5, pp 284-292

Recent care of common mental disorders in the united states

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Abstract

OBJECTIVE: To relate the presence of recent mental disorders to use of mental health services.

DESIGN: Cross-sectional survey.

STUDY POPULATION: The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines.

MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving any mental health care and guidelineconcordant care were measured. Although 53.8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidencebased treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage.

CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.

The research reported here was carried out with support from the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development. A complete list of publications and supporting documentation for the Midlife Development in the United States (MIDUS) survey appear on the MIDUS Web page at http://midmac.med.harvard.edu/research.html. Preparation of the report was also supported by National Institute of Mental Health grants K01-MH01651 to Dr. Wang and K05-MH00507 to Dr. Kessler.