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.
mental disorders depression anxiety mental health care guideline concordance
This is a preview of subscription content, log in to check access.
Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994;51:8–19.PubMedGoogle Scholar
Simon G, Ormel J, von Korff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–7.PubMedGoogle Scholar
Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry. 1998;34(suppl):4–9.Google Scholar
Rice DP, Miller LS. The economic burden of affective disorders. Br J Psychiatry. 1995;166:34–42.Google Scholar
Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression in 1990. J Clin Psychiatry. 1993;54:405–18.PubMedGoogle Scholar
Elkin I, Shea MT, Watkins JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry. 1989;46:971–82.PubMedGoogle Scholar
Mintz J, Mintz LI, Arruda MJ, Hwang SS. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry. 1992;49:761–8.PubMedGoogle Scholar
Kupfer D, Frank E, Perel JM, et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992;49:769–73.PubMedGoogle Scholar
Agency for Health Care Policy and Research. Depression in Primary Care, Vol. 2: Treatment of Major Depression. Rockville, Md: US Dept of Health and Human Services; 1993.Google Scholar
American Psychiatric Association. Practice guideline for major depressive disorder in adults. Am J Psychiatry. 1993;150(suppl):1–26.Google Scholar
American Psychiatric Association. Practice Guideline for Treatment of Patients with Panic Disorder. Washington, DC: American Psychiatric Association Press; 1998.Google Scholar
Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York, NY: The Free Press; 1991.Google Scholar
Katz SJ, Kessler RC, Lin E, Wells KB. Medication management of depression in the United States and Ontario. J Gen Intern Med. 1998;13:77–85.PubMedCrossRefGoogle Scholar
McFarland B. Cost-effectiveness considerations for managed care systems: treating depression in primary care. Am J Med. 1994;97(suppl 6a):S47-S57.CrossRefGoogle Scholar
Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA. 1997;277:333–40.PubMedCrossRefGoogle Scholar
McGlynn EA. Choosing chronic disease measures for HEDIS: conceptual framework and review of seven clinical areas. Manag Care Q. 1996;4:54–77.PubMedGoogle Scholar
National Committee for Quality Insurance. Health Plan Employer Data and Information Set. Washington, DC: National Committee for Quality Insurance; 1996.Google Scholar
Leaf PJ, Bruce ML, Tischler GL, Freeman DH, Weissman MM, Myers JK. Factors affecting utilization of specialty and general medical mental health services. Med Care. 1988;26:9–26.PubMedCrossRefGoogle Scholar
Horgan C. The demand for ambulatory mental services from specialty providers. Health Serv Res.1986;21:291–319.PubMedGoogle Scholar
Wells KB, Katon W, Rogers B, Camp P. Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the Medical Outcomes Study. Am J Psychiatry. 1994;151:694–700.PubMedGoogle Scholar
Johnson RE, McFarland BH. Treated prevalence rates of severe mental illness among HMO members. Hosp Community Psychiatry. 1994;45:919–24.PubMedGoogle Scholar
Cooper-Patrick L, Crum RM, Ford DE. Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Med Care. 1994;32:15–24.PubMedCrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed, revised. Washington, DC: American Psychiatric Association Press; 1987.Google Scholar
Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U. The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). Int J Methods Psychiatr Res. 1998;7:171–85.CrossRefGoogle Scholar
Wittchen HU. Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57–84.PubMedCrossRefGoogle Scholar
Kessler RC, Berglund PA, Zhao S, et al. The 12-month prevalence and correlates of Serious Mental Illness (SMI). In: Manderscheid RW, Sonnenschein MA, eds. Mental Health, United States 1996. Washington, DC: US Govt Printing Office; 1996.Google Scholar
Simon GE, von Korff M, Durham ML. Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization. Am J Psychiatry. 1994;151:908–13.PubMedGoogle Scholar
Schwenk TL, Coyne JC, Fechner-Bates S. Difference between detected and undetected patients in primary care and depressed psychiatric patients. Gen Hosp Psychiatry. 1996;18:407–15.PubMedCrossRefGoogle Scholar
Ormel J, Van Den Bring W, Koeter MWJ, Van Der Meer K, Van de Willige G, Wilmink FW. Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med. 1990;20:909–23.PubMedCrossRefGoogle Scholar
Weddington WH, Gabel LL, Peet GM, Stewart SO. Quality of care and black American patients. J Natl Med Assoc. 1992;84:569–75.PubMedGoogle Scholar
Kahn KL, Pearson ML, Harrison ER, et al. Health care for black and poor hospitalized Medicare patients. JAMA. 1994;271:1169–74.PubMedCrossRefGoogle Scholar
Cooper-Patrick L, Gallo JJ, Power NR, Steinwachs DM, Eaton WW, Ford DE. Mental health service utilization by African Americans and whites. Med Care. 1999;37:1034–45.PubMedCrossRefGoogle Scholar
Klinkman MS. Competing demands in psychosocial care: a model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry. 1997;19:98–111.PubMedCrossRefGoogle Scholar