Hostname: page-component-5d59c44645-lfgmx Total loading time: 0 Render date: 2024-02-25T01:38:51.369Z Has data issue: false hasContentIssue false

Common mental disorder diagnosis and need for treatment are not the same: findings from a population-based longitudinal survey

Published online by Cambridge University Press:  07 December 2012

J. Sareen*
Affiliation:
Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
C. A. Henriksen
Affiliation:
Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, MB, Canada
M. B. Stein
Affiliation:
Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
T. O. Afifi
Affiliation:
Departments of Community Health Sciences, Psychiatry, and Family Social Sciences, University of Manitoba, Winnipeg, MB, Canada
L. M. Lix
Affiliation:
School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
M. W. Enns
Affiliation:
Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
*
*Address for correspondence: J. Sareen, M.D., PZ430-771 Bannatyne Avenue, Winnipeg, MB, CanadaR3E 3N4. (Email: sareen@cc.umanitoba.ca)

Abstract

Background

Controversy exists regarding whether people in the community who meet criteria for a non-psychotic mental disorder diagnosis are necessarily in need of treatment. Some have argued that these individuals require treatment and that policy makers need to develop outreach programs for them, whereas others have argued that the current epidemiologic studies may be diagnosing symptoms of distress that in many cases are self-limiting and likely to remit without treatment. All prior studies that have addressed this issue have been cross-sectional. We examined the longitudinal outcomes of individuals with depressive, anxiety and substance use (DAS) disorder(s) who had not previously received any treatment.

Method

Data came from a nationally representative US sample. A total of 34 653 non-institutionalized adults (age ≥20 years) were interviewed at two time points, 3 years apart. DAS disorders, mental health service use and quality of life (QoL) were assessed at both time points.

Results

Individuals with a DAS disorder who had not previously received any treatment were significantly more likely than those who had been previously treated to have remission of their index disorder(s) without subsequent treatment, to be free of co-morbid disorder(s) and not to have attempted suicide during the 3-year follow-up period (50.7% v. 33.0% respectively, p < 0.05). At wave 2, multiple linear regression demonstrated that people with a remission of their baseline DAS disorder(s) had levels of functioning similar to those without a DAS disorder.

Conclusions

Individuals with an untreated DAS disorder at baseline have a substantial likelihood of remission without any subsequent intervention.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Afifi, TO, Enns, MW, Cox, BJ, de Graaf, R, ten Have, M, Sareen, J (2007). Child abuse and health-related quality of life in adulthood. Journal of Nervous and Mental Disease 195, 797804.CrossRefGoogle ScholarPubMed
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, 3346.CrossRefGoogle ScholarPubMed
Bernstein, DP, Fink, L, Handelsman, L, Foote, J (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry 151, 11321136.Google ScholarPubMed
Compton, WM, Grant, BF, Colliver, JD, Glantz, MD, Stinson, FS (2004). Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. Journal of the American Medical Association 291, 21142121.CrossRefGoogle ScholarPubMed
de Graaf, R, Bijl, RV, Smit, F, Ravelli, A, Vollebergh, WA (2000). Psychiatric and sociodemographic predictors of attrition in a longitudinal study: The Netherlands Mental Health Survey and Incidence Study (NEMESIS). American Journal of Epidemiology 152, 10391047.CrossRefGoogle Scholar
Druss, BG, Wang, PS, Sampson, NA, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2007). Understanding mental health treatment in persons without mental diagnoses: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 64, 11961203.CrossRefGoogle ScholarPubMed
Eaton, WW, Anthony, JC, Tepper, S, Dryman, A (1992). Psychopathology and attrition in the epidemiologic catchment area surveys. American Journal of Epidemiology 135, 10511059.CrossRefGoogle ScholarPubMed
El-Gabalawy, R, Katz, LY, Sareen, J (2010). Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosomatic Medicine 72, 641647.CrossRefGoogle Scholar
Grant, BF, Goldstein, RB, Chou, SP, Huang, B, Stinson, FS, Dawson, DA, Saha, TD, Smith, SM, Pulay, AJ, Pickering, RP, Ruan, WJ, Compton, WM (2009). Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Molecular Psychiatry 14, 10511066.CrossRefGoogle ScholarPubMed
Hasin, DS, Goodwin, RD, Stinson, FS, Grant, BF (2005). Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry 62, 10971106.CrossRefGoogle ScholarPubMed
Katon, WJ, Lin, EH, Von Korff, M, Ciechanowski, P, Ludman, EJ, Young, B, Peterson, D, Rutter, CM, McGregor, M, McCulloch, D (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine 363, 26112620.CrossRefGoogle ScholarPubMed
Kendler, KS, Gallagher, TJ, Abelson, JM, Kessler, RC (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Archives of General Psychiatry 53, 10221031.CrossRefGoogle Scholar
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005 a). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.CrossRefGoogle ScholarPubMed
Kessler, RC, Demler, O, Frank, RG, Olfson, M, Pincus, HA, Walters, EE, Wang, P, Wells, KB, Zaslavsky, AM (2005 b). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.CrossRefGoogle ScholarPubMed
Kessler, RC, Frank, RG, Edlund, M, Katz, SJ, Lin, E, Leaf, P (1997). Differences in the use of psychiatric outpatient services between the United States and Ontario. New England Journal of Medicine 336, 551557.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 819.CrossRefGoogle ScholarPubMed
Kessler, RC, Merikangas, KR, Berglund, P, Eaton, WW, Koretz, DS, Walters, EE (2003). Mild disorders should not be eliminated from the DSM-V. Archives of General Psychiatry 60, 11171122.CrossRefGoogle Scholar
Mechanic, D (2003). Is the prevalence of mental disorders a good measure of the need for services? Health Affairs 22, 820.CrossRefGoogle ScholarPubMed
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, 7784.CrossRefGoogle ScholarPubMed
Mojtabai, R, Olfson, M, Sampson, NA, Jin, R, Druss, B, Wang, PS, Wells, KB, Pincus, HA, Kessler, RC (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological Medicine 41, 17511761.CrossRefGoogle ScholarPubMed
Narrow, WE, Rae, DS, Robins, LN, Regier, DA (2002). Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. Archives of General Psychiatry 59, 115123.CrossRefGoogle ScholarPubMed
Pagura, J, Katz, LY, Mojtabai, R, Druss, BG, Cox, B, Sareen, J (2011). Antidepressant use in the absence of common mental disorders in the general population. Journal of Clinical Psychiatry 72, 494501.CrossRefGoogle ScholarPubMed
Palmetto, NP, Link, BG (2010). The reliability of adult lifetime suicide attempt reports in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Comprehensive Psychiatry 51, e8.CrossRefGoogle Scholar
Regier, DA, Kaelber, CT, Rae, DS, Farmer, ME, Knauper, B, Kessler, RC, Norquist, GS (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders: implications for research and policy. Archives of General Psychiatry 55, 109115.CrossRefGoogle ScholarPubMed
Regier, DA, Narrow, WE, Rae, DS (2004). For DSM-V, it's the ‘disorder threshold,’ stupid. Archives of General Psychiatry 61, 1051; author reply 1051–1052.CrossRefGoogle ScholarPubMed
Rhodes, AE, Fung, K (2004). Self-reported use of mental health services versus administrative records: care to recall? International Journal of Methods in Psychiatric Research 13, 165175.CrossRefGoogle ScholarPubMed
Roy-Byrne, P, Craske, MG, Sullivan, G, Rose, RD, Edlund, MJ, Lang, AJ, Bystritsky, A, Welch, SS, Chavira, DA, Golinelli, D, Campbell-Sills, L, Sherbourne, CD, Stein, MB (2010). Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. Journal of the American Medical Association 303, 19211928.CrossRefGoogle ScholarPubMed
Ruan, WJ, Goldstein, RB, Chou, SP, Smith, SM, Saha, TD, Pickering, RP, Dawson, DA, Huang, B, Stinson, FS, Grant, BF (2008). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence 92, 2736.CrossRefGoogle Scholar
Sareen, J, Cox, BJ, Afifi, TO, Clara, I, Yu, BN (2005 a). Perceived need for mental health treatment in a nationally representative Canadian sample. Canadian Journal of Psychiatry 50, 447455.Google Scholar
Sareen, J, Cox, BJ, Afifi, TO, Yu, BN, Stein, MB (2005 b). Mental health service use in a nationally representative Canadian survey. Canadian Journal of Psychiatry 50, 7381.Google Scholar
Sareen, J, Fleisher, W, Cox, BJ, Hassard, S, Stein, MB (2005 c). Childhood adversity and perceived need for mental health care: findings from a Canadian community sample. Journal of Nervous and Mental Disease 193, 396404.CrossRefGoogle ScholarPubMed
Sareen, J, Jacobi, F, Cox, BJ, Belik, SL, Clara, I, Stein, MB (2006). Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of Internal Medicine 23, 21092116.CrossRefGoogle Scholar
Sareen, J, Jagdeo, A, Cox, BJ, ten Have, M, Clara, I, de Graaf, R, Belik, SL, Stein, MB (2007). Perceived barriers toward mental health service utilization: a comparison of epidemiologic surveys in the United States, Ontario and the Netherlands. Psychiatric Services 58, 357364.CrossRefGoogle Scholar
Sareen, J, Stein, MB, Campbell, DW, Hassard, T, Menec, V (2005 d). The relationship between perceived need for mental health treatment, DSM diagnosis and quality of life: a Canadian population-based survey. Canadian Journal of Psychiatry 50, 173180.CrossRefGoogle Scholar
Shah, BV, Barnswell, BG, Bieler, GS (1995). SUDAAN User's Manual: Software for Analysis of Correlated Data. Research Triangle Institute: Research Triangle Park, NC.Google Scholar
Straus, MA (1990). Measuring intrafamily conflict and violence: the Conflict Tactics (CT) scales. In Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,125 Families (ed. Straus, M. A. and Gelles, R. J.), pp. 2947. Transaction: New Brunswick, NJ.Google Scholar
SUDAAN (2000). SUDAAN: Software for the Statistical Analysis of Correlated Data, Release 7.5. Research Triangle Institute: Research Triangle Park, NC.Google Scholar
Wakefield, JC (2012). DSM-5: proposed changes to depressive disorders. Current Medical Research and Opinion 28, 335343.CrossRefGoogle ScholarPubMed
Wakefield, JC, Schmitz, MF, First, MB, Horwitz, AV (2007). Extending the bereavement exclusion for major depression to other losses: evidence from the National Comorbidity Survey. Archives of General Psychiatry 64, 433440.CrossRefGoogle ScholarPubMed
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, 841850.CrossRefGoogle ScholarPubMed
Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (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, 603613.CrossRefGoogle ScholarPubMed
Ware, JEJ, Kosinski, M, Keller, S (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220233.CrossRefGoogle ScholarPubMed