[Estimation of prevalence and treatment needs of mental disorders. The problem of diagnostic thresholds]

[Epidemic of depression? : Development of prevalence and help-seeking behaviour]

BACKGROUND

While national health insurance companies in Germany have reported increasing frequencies of depression and growing costs since the first reports approximately 20 years ago, the prevalence from epidemiological field studies has remained stable in the general population. This study examined time trends in help-seeking behaviour for depression based on data from the German health monitoring programme at the Robert Koch Institute.

METHODS

Data were obtained from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, 18-65 years, n = 3320) and the mental health supplement of the German National Health Interview and Examination Survey 1998 (GHS-MHS, 1997-1999; 18-65 years, n = 4181). Persons with 12-month major depressive disorder standardized according to DSM IV were identified based on the WHO Composite International Diagnostic Interview (CIDI) and asked for information on service utilization due to mental health problems by type of sector and service provider (GHS-MHS: n = 346, DEGS1-MH: n = 229).

RESULTS

Overall, there were no significant time trends with respect to self-reported service utilization. Help seeking by men with depression increased in making contact with respect to psychotherapy and psychology options. Worrying about stigmatization and lack of knowledge about professional help were identified as individual barriers for help seeking and nearly one quarter reported access barriers.

CONCLUSION

Overall, increasing frequencies of depression in the German healthcare system cannot be solely attributed to changes in help-seeking behavior of people with depression. Self-reported barriers of service utilization and divergences between primary and secondary data indicate the need of further evaluation and optimization of mental healthcare provision in Germany.

[Provision of outpatient specialist care for mental disorders : Minor regional differences in treatment needs, major regional differences in availability]

BACKGROUND

Due to the high burden attributed to mental disorders, an important purpose of a general healthcare system is to provide comprehensive medical specialist care that is both locally available and in line with demand; however, the density of outpatient physicians and psychotherapists significantly varies between regions in Germany. To verify if these variations reflect regional variations of morbidity rates, routine data of statutory health insurance companies are analyzed on a regular basis. But these administrative data directly depend on the actual regional health care supply. Hence, independent epidemiological data on prevalence rates of mental disorders could be a valuable supplement.

METHODS

Analyses are based on prevalence rates of the representative epidemiological German health interview and examination survey and its mental health module (DEGS1-MH) as well as supplemental data from the German national and regional associations of statutory health insurance physicians. The associations between prevalence rates and density of outpatient physicians and psychotherapists were computed for the DEGS sample points, representing 139 different German districts. Transregional care provision for neighboring regions was taken into account.

RESULTS

There were neither significant associations of regional density of outpatient physicians and psychotherapists with prevalence rates of mental disorders in general nor with prevalence rates of severe mental disorders; however, taking into account transregional care provision for neighboring regions the huge variability of provider density decreases.

DISCUSSION

The regional inequality of physician and psychotherapist density cannot be explained by regional differences in treatment needs. The results indicate potential improvements in healthcare provision for mental disorders in Germany through the adaptation to actual morbidity rates; however, the definition of treatment needs in mental disorders requires further evaluation.