Advertisement

Mental health service use and treatment adequacy for anxiety disorders in Canada

  • Pasquale RobergeEmail author
  • Louise Fournier
  • Arnaud Duhoux
  • Cat Tuong Nguyen
  • Mirrian Smolders
Original Paper

Abstract

Background

This study examined mental health service use, minimal standards of treatment adequacy and correlates of service use and treatment adequacy for anxiety disorders in Canada.

Method

Data were drawn from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2, 2002). Respondents (n = 1,803) met criteria for panic disorder, agoraphobia and/or social phobia in the past 12 months. Multiple logistic regression models were used to estimate patterns of associations between respondent characteristics, service use and treatment adequacy.

Results

The prevalence of service use for mental health problems in the past 12 months was approximately 36.9% among respondents with anxiety disorders. The rates of minimal standards of treatment adequacy ranged from 36.8% among those consulting exclusively in primary care to 51.5% among those consulting exclusively in specialised mental health services, and reached 79.5% for respondents consulting healthcare professionals in both sectors of care. Correlates of treatment adequacy included age, education level, marital status, urbanicity medical insurance, acceptability of care, comorbid mental disorders and limitations of activities.

Conclusion

These findings emphasize the need to improve the access to mental health services and the quality of care for individuals with anxiety disorders in primary care.

Keywords

Anxiety disorders Health care utilisation Mental health services Treatment adequacy 

Notes

Acknowledgments

This project was supported by postdoctoral fellowships to the first author from the Fonds de la recherche en santé du Québec and the Transdisciplinary Training Program in Public and Population Health Research, a Canadian Institutes of Health Research Strategic Training Initiative. While the research and analysis in the report are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada.

References

  1. 1.
    Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ (1999) The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60:427–435PubMedCrossRefGoogle Scholar
  2. 2.
    Lepine JP (2002) The epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatry 63(Suppl 14):4–8Google Scholar
  3. 3.
    DuPont RL, Rice DP, Miller LS, Shiraki SS, Rowland CR, Harwood HJ (1996) Economic costs of anxiety disorders. Anxiety 2:167–172PubMedCrossRefGoogle Scholar
  4. 4.
    Issakidis C, Andrews G (2002) Service utilisation for anxiety in an Australian community sample. Soc Psychiatry Psychiatr Epidemiol 37:153–163PubMedCrossRefGoogle Scholar
  5. 5.
    Lesage A, Vasiliadis HM, Gagne MA, Dudgeon S, Kasman N, Hay C (2006) Prévalence de la maladie mentale et utilisation des services connexes au Canada: une analyse des données de l’Enquête sur la santé dans les collectivités canadiennes. Canadian Collaborative Mental Health Initiative, Mississauga (ON)Google Scholar
  6. 6.
    Roy-Byrne PP, Wagner AW, Schraufnagel TJ (2005) Understanding and treating panic disorder in the primary care setting. J Clin Psychiatry 66(Suppl 4):16–22Google Scholar
  7. 7.
    Canadian Psychiatric Association (2006) Clinical practice guidelines: management of anxiety disorders. Can J Psychiatry 51:1S–97SGoogle Scholar
  8. 8.
    Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370:841–850PubMedCrossRefGoogle Scholar
  9. 9.
    Fernandez A, Haro JM, Martinez-Alonso M, Demyttenaere K, Brugha TS, Autonell J, de Girolamo G, Bernert S, Lepine JP, Alonso J (2007) Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry 190:172–173PubMedCrossRefGoogle Scholar
  10. 10.
    Fernandez A, Haro JM, Codony M, Vilagut G, Martinez-Alonso M, Autonell J, Salvador-Carulla L, Ayuso-Mateos JL, Fullana MA, Alonso J (2006) Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain. J Affect Disord 96:9–20PubMedCrossRefGoogle Scholar
  11. 11.
    Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, Sullivan G, Roy-Byrne PP (2004) Quality of care for primary care patients with anxiety disorders. Am J Psychiatry 161:2230–2237PubMedCrossRefGoogle Scholar
  12. 12.
    Wang PS, Berglund P, Kessler RC (2000) Recent care of common mental disorders in the United States: prevalence and conformance with evidence-based recommendations. J Gen Intern Med 15:284–292PubMedCrossRefGoogle Scholar
  13. 13.
    Wang PS, Demler O, Kessler RC (2002) Adequacy of treatment for serious mental illness in the United States. Am J Public Health 92:92–98PubMedCrossRefGoogle Scholar
  14. 14.
    Young AS, Klap R, Sherbourne CD, Wells KB (2001) The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry 58:55–61PubMedCrossRefGoogle Scholar
  15. 15.
    Gravel R, Beland Y (2005) The Canadian Community Health Survey: mental health and well-being. Can J Psychiatry 50:573–579PubMedGoogle Scholar
  16. 16.
    Kessler RC, Ustun TB (2004) The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatric Res 13:93–121CrossRefGoogle Scholar
  17. 17.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (4th ed) American Psychiatric Association, Washington, DCGoogle Scholar
  18. 18.
    Roberge P, Marchand A, Reinharz D, Savard P (2008) Cognitive-behavioral treatment for panic disorder with agoraphobia: a randomized, controlled trial and cost-effectiveness analysis. Behav Modif 32:333–351PubMedCrossRefGoogle Scholar
  19. 19.
    Goodwin R, Andersen RM (2002) Use of the behavioral model of health care use to identify correlates of use of treatment for panic attacks in the community. Soc Psychiatry Psychiatr Epidemiol 37:212–219PubMedCrossRefGoogle Scholar
  20. 20.
    Westat (2003) WesVar 4.2 user’s guide. Westat, Rockville (MD)Google Scholar
  21. 21.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:629–640PubMedCrossRefGoogle Scholar
  22. 22.
    Duhoux A, Fournier L, Nguyen CT, Roberge P, Beveridge R (2009) Guideline concordance of treatment for depressive disorders in Canada. Soc Psychiatry Psychiatr Epidemiol 44:385–392PubMedCrossRefGoogle Scholar
  23. 23.
    Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. J Am Med Assoc 291:2581–2590CrossRefGoogle Scholar
  24. 24.
    Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB (2000) Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med 15:381–388PubMedCrossRefGoogle Scholar
  25. 25.
    Fuller J, Edwards J, Martinez L, Edwards B, Reid K (2004) Collaboration and local networks for rural and remote primary mental healthcare in South Australia. Health Soc Care Community 12:75–84PubMedCrossRefGoogle Scholar
  26. 26.
    McCabe S, Macnee CL (2002) Weaving a new safety net of mental health care in rural America: a model of integrated practice. Issues Ment Health Nurs 23:263–278PubMedCrossRefGoogle Scholar
  27. 27.
    Starkes JM, Poulin CC, Kisely SR (2005) Unmet need for the treatment of depression in Atlantic Canada. Can J Psychiatry 50:580–590PubMedGoogle Scholar
  28. 28.
    Heuzenroeder L, Donnelly M, Haby MM, Mihalopoulos C, Rossell R, Carter R, Andrews G, Vos T (2004) Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Aust N Z J Psychiatry 38:602–612PubMedGoogle Scholar
  29. 29.
    Sareen J, Jagdeo A, Cox BJ, Clara I, ten Have M, Belik SL, de Graaf R, Stein MB (2007) Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychiatr Serv 58:357–364PubMedCrossRefGoogle Scholar
  30. 30.
    Thompson A, Hunt C, Issakidis C (2004) Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Soc Psychiatry Psychiatr Epidemiol 39:810–817PubMedGoogle Scholar
  31. 31.
    Jorm AF, Christensen H, Griffiths KM (2005) The impact of beyondblue: the national depression initiative on the Australian public’s recognition of depression and beliefs about treatments. Aust N Z J Psychiatry 39(4):248–254PubMedGoogle Scholar
  32. 32.
    Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat CW, de GG, Fayyad J, Gureje O, Haro JM, Huang Y, Kessler RC, Kovess V, Levinson D, Nakane Y, Oakley Brown MA, Ormel JH, Posada-Villa J, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Chatterji S, Ustun TB (2007) Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6:177–185Google Scholar
  33. 33.
    Gilbody SM, Whitty PM, Grimshaw JM, Thomas RE (2003) Improving the detection and management of depression in primary care. Qual Saf Health Care 12:149–155PubMedCrossRefGoogle Scholar
  34. 34.
    Rhodes AE, Fung K (2004) Self-reported use of mental health services versus administrative records: care to recall? Int J Methods Psychiatric Res 13:165–175CrossRefGoogle Scholar
  35. 35.
    Wang PS, Demler O, Olfson M, Pincus HA, Wells KB, Kessler RC (2006) Changing profiles of service sectors used for mental health care in the United States. Am J Psychiatry 163:1187–1198PubMedCrossRefGoogle Scholar
  36. 36.
    Smolders M, Laurant M, Roberge P, van Balkom A, van Rijswijk E, Bower P, Grol R (2008) Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety. Can J Psychiatry 53:277–293PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Pasquale Roberge
    • 1
    • 2
    • 3
    Email author
  • Louise Fournier
    • 1
    • 2
    • 3
  • Arnaud Duhoux
    • 1
    • 3
  • Cat Tuong Nguyen
    • 1
  • Mirrian Smolders
    • 4
  1. 1.Department of Social and Preventive Medicine, Faculty of MedicineUniversity of MontrealMontrealCanada
  2. 2.Research Centre of the University of Montreal Hospital Centre (CRCHUM)MontrealCanada
  3. 3.Institut National de Santé Publique du QuébecMontrealCanada
  4. 4.Scientific Institute for Quality of Health CareRadboud University Nijmegen Medical Centre (RUNMC)NijmegenThe Netherlands

Personalised recommendations