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Filters on the pathway to mental health care I. Incident mental disorders

Published online by Cambridge University Press:  09 July 2009

S. Marino ,
J. J. Gallo ,
D. Ford  and
J. C. Anthony
S. Marino
Affiliation:
Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA; Department of Medical Psychology, Institute of Psychiatry, University of Verona, Verona, Italy
J. J. Gallo
Affiliation:
Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA; Department of Medical Psychology, Institute of Psychiatry, University of Verona, Verona, Italy
D. Ford
Affiliation:
Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA; Department of Medical Psychology, Institute of Psychiatry, University of Verona, Verona, Italy
J. C. Anthony*
Affiliation:
Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA; Department of Medical Psychology, Institute of Psychiatry, University of Verona, Verona, Italy
*
1Address for correspondence: Dr James C. Anthony, Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway, Baltimore, Maryland 21205, USA.
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Synopsis

This study investigates health and mental health services use by adults with and without newly incident mental disorders and uses prospectively gathered data from the Epidemiologic Catchment Area Program, a multi-site interview survey of adult household residents in the United States. Study subjects were 13400 participants who completed interviews in the initial survey and also in a follow-up 1 year later, and who reported no contact with mental health services in either the specialized mental health sector or in the general medical sector in the 6 months prior to the initial survey. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. ‘Hierarchical’ and ‘filter’ models of mental health services provide frameworks useful in understanding the possible effects of specific categories of psychiatric disturbances on use of health services. Only a minority of individuals with newly incident psychiatric disorder report discussion of mental health issues in a health care setting. Persons who developed a mental disorder during the follow-up interval were just as likely to consult a non-psychiatrist physician for their mental health problems as to consult a specialist in mental health, even accounting for other factors known to be associated with differential use of health care services. This large community study of incident psychiatric disorders strengthens prior evidence on the importance of the general medical sector in the care of individuals with psychiatric disturbances.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 6 , November 1995 , pp. 1135 - 1148
Copyright
Copyright © Cambridge University Press 1995

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