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

  • Risë B. GoldsteinEmail author
  • Mark Olfson
  • Elaine Goff Martens
  • Susan I. Wolk
Original Paper



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.


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.


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.


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.


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



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.


  1. Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly, 51, 95–124.CrossRefGoogle Scholar
  2. Aoun, S., Pennebaker, D., & Wood, C. (2004). Assessing population need for mental health care: A review of approaches and predictors. Mental Health Services Research, 6, 33–46.PubMedCrossRefGoogle Scholar
  3. Blumenthal, R., & Endicott, J. (1996/1997). Barriers to seeking treatment for major depression. Depression and Anxiety, 4, 273–278.CrossRefGoogle Scholar
  4. Chambers, W. J., Puig-Antich, J., Hirsch, M., Paez, P., Ambrosini, P., Tabrizi, M., et al. (1985). The assessment of affective disorders in children and adolescents by semistructured interviews. Archives of General Psychiatry, 42, 696–702.PubMedGoogle Scholar
  5. Chander, G., & McCaul, M. E. (2003). Co-occurring psychiatric disorders in women with addictions. Obstetrics and Gynecology Clinics of North America, 30, 469–481.PubMedCrossRefGoogle Scholar
  6. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  7. Compas, B. E., Oppedisano, G., Connor, J. K., Hinden, B. R., Achenbach, T. M., & Hammen, C. (1997). Gender differences in depressive symptoms in adolescence: Comparison of national samples of clinically referred and nonreferred youths. Journal of Consulting and Clinical Psychology, 65, 617–626.PubMedCrossRefGoogle Scholar
  8. Dawson, R., Lavori, P. W., Coryell, W. H., Endicott, J., & Keller, M. B. (1999). Course of treatment received by depressed patients. Journal of Psychiatric Research, 33, 233–242.PubMedCrossRefGoogle Scholar
  9. Etheridge, R. M., Craddock, S. G., Dunteman, G. H., & Hubbard, R. L. (1995). Treatment services in two national studies of community-based drug abuse treatment programs. Journal of Substance Abuse, 7, 9–26.PubMedCrossRefGoogle Scholar
  10. Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, K. H., et al. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27, 1145–1154.PubMedCrossRefGoogle Scholar
  11. Forthofer, M. S., Kessler, R. C., Story, A. L., & Gotlib, I. H. (1996). The effects of psychiatric disorders on the probability and timing of first marriage. Journal of Health and Social Behavior, 37, 121–132.PubMedCrossRefGoogle Scholar
  12. Goodwin, R., & Andersen, R. M. (2002). Use of the Behavioral Model of Health Care Use to identify correlates of use of treatment for panic attacks in the community. Social Psychiatry and Psychiatric Epidemiology, 37, 212–219.PubMedCrossRefGoogle Scholar
  13. Hirschfeld, R. M., Keller, M. B., Panico, S., Arons, B. S., Barlow, D., & Davidoff, F., et al. (1997). The national depressive and manic-depressive association consensus statement on the undertreatment of depression. Journal of the American Medical Association, 277, 333–340.PubMedCrossRefGoogle Scholar
  14. Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: John Wiley and Sons, Inc.CrossRefGoogle Scholar
  15. Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U. S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.PubMedCrossRefGoogle Scholar
  16. Katz, S. J., Kessler, R. C., Frank, R. G., Leaf, P., & Lin, E. (1997). Mental health care use, morbidity, and socioeconomic status in the United States and Ontario. Inquiry, 34, 38–49.PubMedGoogle Scholar
  17. Kessler, R. (1986). Sex differences in the use of health services. In: S. McHugh & M. Vallis (Eds.), Illness behavior: A multidisciplinary model (pp. 135–148). New York: Plenum.Google Scholar
  18. Kessler, R. C., Berglund, P. A., Foster, C. L., Saunders, W. B., Stang, P. E., & Walters, E. E. (1997). Social consequences of psychiatric disorders, II: Teenage parenthood. American Journal of Psychiatry, 154, 1405–1411.PubMedGoogle Scholar
  19. Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352, 2515–2523.PubMedCrossRefGoogle Scholar
  20. Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026–1032.PubMedGoogle Scholar
  21. Kessler, R. C., Olfson, M., & Berglund, P. A. (1998a). Patterns and predictors of treatment contact after first onset of psychiatric disorders. American Journal of Psychiatry, 155, 62–69.Google Scholar
  22. Kessler, R. C., Walters, E. E., & Forthofer, M. S. (1998b). Social consequences of psychiatric disorders, III: Probability of marital stability. American Journal of Psychiatry, 155, 1092–1096.Google Scholar
  23. Leckman, J. F., Sholomskas, D., Thompson, W. D., Bélanger, A., & Weissman, M. M. (1982). Best estimate of lifetime psychiatric diagnosis: A methodological study. Archives of General Psychiatry, 39, 879–883.PubMedGoogle Scholar
  24. McLellan, A. T., & Druley, K. A. (1977). The readmitted drug patient: Evidence of failure or gradual success? Hospital and Community Psychiatry, 28, 764–766.PubMedGoogle Scholar
  25. Mannuzza, S., Fyer, A. J., Klein, D. F., & Endicott, J. (1986). Schedule for Affective Disorders and Schizophrenia, Lifetime Version (modified for the study of anxiety disorders): Rationale and conceptual development. Journal of Psychiatric Research, 20, 317–325.PubMedCrossRefGoogle Scholar
  26. Mojtabai, R., Olfson, M., & Mechanic, D. (2002). Perceived need and help seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry, 59, 77–84.PubMedCrossRefGoogle Scholar
  27. Newman, S. C., & Bland, R. C. (1998). Incidence of mental disorders in Edmonton: Estimates of rates and methodological issues. Journal of Psychiatric Research, 32, 273–282.PubMedCrossRefGoogle Scholar
  28. Patten, S. B. (2003). Recall bias and major depression lifetime prevalence. Social Psychiatry and Psychiatric Epidemiology, 38, 290–296.PubMedGoogle Scholar
  29. Pearse, W. H. (1994). The Commonwealth Fund Women’s Health Survey: Selected results and comments. Women’s Health Issues, 4, 38–47.PubMedCrossRefGoogle Scholar
  30. Puig-Antich, J., Lukens, E., Davies, M., Goetz, D., Brennan-Quattrock, J., & Todak, G. (1985a). Psychosocial functioning in prepubertal major depressive disorders, I: Interpersonal relationships during the depressive episode. Archives of General Psychiatry, 42, 500–507.Google Scholar
  31. Puig-Antich, J., Lukens, E., Davies, M., Goetz, D., Brennan-Quattrock, J., & Todak, G. (1985b). Psychosocial functioning in prepubertal major depressive disorders. II. Interpersonal relationships after sustained recovery from the depressive episode. Archives of General Psychiatry, 42, 511–517.Google Scholar
  32. SAS Institute, Inc. (1999). SAS Statistical Software, version 8. Cary, NC: Author.Google Scholar
  33. Shi, L. (2001). The convergence of vulnerable characteristics and health insurance in the U.S. Social Science and Medicine, 53, 519–529.PubMedCrossRefGoogle Scholar
  34. Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research diagnostic criteria: Rationale and reliability. Archives of General Psychiatry, 35, 773–782.PubMedGoogle Scholar
  35. Tanner, J. M. (1962). Growth at adolescence: With a general consideration of effects of hereditary and environmental factors upon growth and maturation from birth to maturity. Oxford, England: Blackwell Scientific Publications.Google Scholar
  36. Wang, P. S., Berglund, P., Olfson, M., & Kessler, R. C. (2004). Delays in initial treatment contact after first onset of a mental disorder. Health Services Research, 39, 393–416.PubMedCrossRefGoogle Scholar
  37. Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 603–613.PubMedCrossRefGoogle Scholar
  38. Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., et al. (1999a). Depressed adolescents grown up. Journal of the American Medical Association, 281, 1707–1713.CrossRefGoogle Scholar
  39. Weissman, M. M., Wolk, S., Wickramaratne, P., Goldstein, R. B., Greenwald, S.,Ryan, N. D., et al. (1999b). Children with prepubertal-onset major depressive disorder and anxiety grown up. Archives of General Psychiatry, 56, 794–801.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Risë B. Goldstein
    • 1
    • 2
    • 4
    Email author
  • Mark Olfson
    • 1
    • 2
  • Elaine Goff Martens
    • 2
    • 3
  • Susan I. Wolk
    • 1
    • 2
  1. 1.Division of Clinical-Genetic Epidemiology, Department of PsychiatryCollege of Physicians and Surgeons of Columbia UniversityNew YorkUSA
  2. 2.Division of Clinical-Genetic EpidemiologyNew York State Psychiatric InstituteNew YorkUSA
  3. 3.Department of NeuroscienceUniversity of Connecticut Health Science CenterFarmingtonUSA
  4. 4.Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological ResearchNational Institute on Alcohol Abuse and AlcoholismBethesdaUSA

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