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