 |
 |

Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication
Philip S. Wang, MD, DrPH;
Patricia Berglund, MBA;
Mark Olfson, MD, MPH;
Harold A. Pincus, MD;
Kenneth B. Wells, MD, MPH;
Ronald C. Kessler, PhD
Arch Gen Psychiatry. 2005;62:603-613.
Context An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder.
Objective To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication.
Design and Setting Nationally representative face-to-face household survey carried out between February 2001 and April 2003.
Participants A total of 9282 respondents aged 18 years and older.
Main Outcome Measures Lifetime DSM-IV disorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetime DSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay.
Results Cumulative lifetime probability curves show that the vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety (27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority).
Conclusions Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.
Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Wang and Kessler); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY (Dr Olfson); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Dr Pincus); Department of Psychiatry and Biobehavioral Sciences (Dr Wells); Department of Psychiatry and Division of Pharmacoepidemiology and Pharmacoeconomics and Brigham and Womens Hospital, Harvard Medical School, Boston (Dr Wang).
RELATED LETTERS
Errors in Assessing DSM-IV Substance Use Disorders
Bridget F. Grant, Wilson M. Compton, Thomas J. Crowley, Deborah S. Hasin, John E. Helzer, Ting-Kai Li, Bruce J. Rounsaville, Nora D. Volkow, and George E. Woody
Arch Gen Psychiatry. 2007;64(3):379-380.
EXTRACT
| FULL TEXT
Drug Use Disorders in the National Comorbidity Survey: Have We Come a Long Way?
Linda B. Cottler
Arch Gen Psychiatry. 2007;64(3):380-381.
EXTRACT
| FULL TEXT
RELATED ARTICLES
Psychiatric Epidemiology: Its Not Just About Counting Anymore
Thomas R. Insel and Wayne S. Fenton
Arch Gen Psychiatry. 2005;62(6):590-592.
EXTRACT
| FULL TEXT
Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler, Patricia Berglund, Olga Demler, Robert Jin, Kathleen R. Merikangas, and Ellen E. Walters
Arch Gen Psychiatry. 2005;62(6):593-602.
ABSTRACT
| FULL TEXT
Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler, Wai Tat Chiu, Olga Demler, and Ellen E. Walters
Arch Gen Psychiatry. 2005;62(6):617-627.
ABSTRACT
| FULL TEXT
Twelve-Month Use of Mental Health Services in the United States: Results From the National Comorbidity Survey Replication
Philip S. Wang, Michael Lane, Mark Olfson, Harold A. Pincus, Kenneth B. Wells, and Ronald C. Kessler
Arch Gen Psychiatry. 2005;62(6):629-640.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Perceived Stigma and Mental Health Care Seeking
Golberstein et al.
Psychiatr. Serv. 2008;59:392-399.
ABSTRACT
| FULL TEXT
A Technological Approach to Reaching a Hidden Population of Problem Drinkers
Lieberman and Huang
Psychiatr. Serv. 2008;59:297-303.
ABSTRACT
| FULL TEXT
Reasons Underlying Treatment Preference: An Exploratory Study
Cochran et al.
J Interpers Violence 2008;23:276-291.
ABSTRACT
Development and Validation of a Brief Mental Health Screening Instrument for Newly Incarcerated Adults
Ford et al.
Assessment 2007;14:279-299.
ABSTRACT
Delay of First Treatment of Mental and Substance Use Disorders in Mexico
Borges et al.
Am. J. Public Health 2007;97:1638-1643.
ABSTRACT
| FULL TEXT
Combat and Peacekeeping Operations in Relation to Prevalence of Mental Disorders and Perceived Need for Mental Health Care: Findings From a Large Representative Sample of Military Personnel
Sareen et al.
Arch Gen Psychiatry 2007;64:843-852.
ABSTRACT
| FULL TEXT
Childhood and Adulthood Psychological Ill Health as Predictors of Midlife Affective and Anxiety Disorders: The 1958 British Birth Cohort
Clark et al.
Arch Gen Psychiatry 2007;64:668-678.
ABSTRACT
| FULL TEXT
Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication
Merikangas et al.
Arch Gen Psychiatry 2007;64:543-552.
ABSTRACT
| FULL TEXT
Impact of psychiatric disorders on health-related quality of life: general population survey
SAARNI et al.
Br. J. Psychiatry 2007;190:326-332.
ABSTRACT
| FULL TEXT
Physical and Mental Comorbidity, Disability, and Suicidal Behavior Associated With Posttraumatic Stress Disorder in a Large Community Sample
Sareen et al.
Psychosom. Med. 2007;69:242-248.
ABSTRACT
| FULL TEXT
Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands
Sareen et al.
Psychiatr. Serv. 2007;58:357-364.
ABSTRACT
| FULL TEXT
Errors in Assessing DSM-IV Substance Use Disorders
Grant et al.
Arch Gen Psychiatry 2007;64:379-380.
FULL TEXT
Drug Use Disorders in the National Comorbidity Survey: Have We Come a Long Way?
Cottler
Arch Gen Psychiatry 2007;64:380-381.
FULL TEXT
National Estimates and Factors Associated With Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder
Visser et al.
Pediatrics 2007;119:S99-S106.
ABSTRACT
| FULL TEXT
The Role of Psychosocial Stress in the Onset and Progression of Bipolar Disorder and its Comorbidities: The Need for Earlier and Alternative Modes of Therapeutic Intervention
Post and Leverich
Focus 2007;5:73-97.
ABSTRACT
| FULL TEXT
Rapid assessments of mental health needs after disasters.
Silove and Bryant
JAMA 2006;296:576-578.
FULL TEXT
Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up
Goldstein et al.
Psychiatr. Serv. 2006;57:966-975.
ABSTRACT
| FULL TEXT
Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children
Wamboldt and Reiss
Am. J. Psychiatry 2006;163:951-953.
FULL TEXT
Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication
Shear et al.
Am. J. Psychiatry 2006;163:1074-1083.
ABSTRACT
| FULL TEXT
The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication.
Kessler et al.
Arch Gen Psychiatry 2006;63:669-678.
ABSTRACT
| FULL TEXT
Committing to Medical Student Education
Roberts et al.
Acad. Psychiatry 2006;30:93-94.
FULL TEXT
The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication.
Kessler et al.
Arch Gen Psychiatry 2006;63:415-424.
ABSTRACT
| FULL TEXT
Treatment strategies after SSRI failure--good news and bad news.
Rubinow
NEJM 2006;354:1305-1307.
FULL TEXT
Mental Illness Treatment Still Elusive for Many
Arehart-Treichel
Psychiatr. News 2005;40:10-11.
FULL TEXT
Psychiatric Epidemiology: It's Not Just About Counting Anymore
Insel and Fenton
Arch Gen Psychiatry 2005;62:590-592.
FULL TEXT
|