Non-disabled cases in a national survey

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey

We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13-18 years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60-3.90) and any service sector (HR = 2.14, CI = 1.45-3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13-2.35), behavior disorders and the school (HR = 3.69, CI = 1.39-9.77) and any service sector (HR = 2.81, CI = 1.12-7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75-8.03), the school (HR = 3.17, CI = 1.43-7.02), and any service sector (HR = 3.66, CI = 2.00-6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34-3.30) and any service sector (HR = 2.03, CI = 1.40-2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12 months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.

Proportion of patients without mental disorders being treated in mental health services worldwide

BACKGROUND

Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather 'the worried well'.

AIMS

To examine the association of past-year mental health treatment with DSM-IV disorders.

METHOD

The World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs.

RESULTS

Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment.

CONCLUSIONS

The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.

Perceived need for mental health care: findings from the 2007 Australian Survey of Mental Health and Wellbeing

OBJECTIVES

To provide an overview of perceived need for mental health care and response of services to those needs as assessed by the general Australian adult population.

METHOD

The Perceived Need for Care Questionnaire was administered to respondents of the Australian 2007 National Survey of Mental Health and Wellbeing. This instrument allows for self assessment of needs for five kinds of intervention from mental health services as needed in the last year. Specific needs assessed included: medication, information, counselling including psychotherapy, social interventions and skills training: Needs for care may be rated as unmet, partially met and met.

RESULTS

Approximately 14% of the population perceived a need for mental health care and between 7% and 8% perceived a met need for either counselling or medication. Need for care was less likely to be perceived by people with substance use disorders than among those with anxiety or affective disorders. For just under half of the population with perceived need (45%), all perceived needs were rated as met, and for around one in five of those with perceived needs, none of their perceived needs were met. Proportionally, needs for medication are most likely to be rated as met at 84%, needs for counselling and information are met at a rate of between 50% and 60%, skills training approximately 40%, and social interventions needs are those least likely to be rated as fully met, at 25%.

CONCLUSIONS

Mental health care is delivered in large volume and often with high levels of acceptability to the Australian community, although major gaps still remain. It appears that the disparity between need and care may be proportionally larger in the areas described as skills training and social interventions than areas outside of conventional mental health service domains of provision and medication and psychotherapy or counselling.

Mental health problems among single and partnered mothers. The role of financial hardship and social support

BACKGROUND

Research has shown elevated levels of common mental disorders among single mothers compared with partnered mothers. The objectives of this analysis were to examine the prevalence of mental health problems among single and partnered mothers and the extent to which this relationship is mediated by socio-demographic, financial and social support variables.

METHODS

Using cross-sectional data from a large, nationally representative longitudinal Australian household survey--the Household Income and Labour Dynamics in Australia (HILDA) Survey--the prevalence of moderate to severe mental disability (as measured by the SF-36) was assessed among 354 single mothers and 1,689 partnered mothers. A series of univariate and simultaneous logistic regression analyses assessed the association between parenting status, the other explanatory variables and mental disability. Mediational analyses were conducted using the 'explained fraction' approach.

RESULTS

The prevalence of moderate to severe mental disability was significantly more pronounced among single mothers (28.7%) compared with partnered mothers (15.7%). Including all explanatory factors--socio-demographic, household income, financial hardship and social support--accounted for 94% of the association between single mother status and poor mental health. Financial hardship and social support were the strongest predictors, accounting for most of the predictive power of the other variables.

CONCLUSIONS

Single mothers are more likely to experience poor mental health than partnered mothers, and the primary factors associated with this are the presence of financial hardship in particular, as well as perceived lack of social support. Future research should examine the extent to which changes in financial hardship among different family types relate to changes in mental health over time, as well as continue to examine variables that may moderate the relationship between social disadvantage and poor mental health.

Disability and the detection of mental disorder in primary care

Despite the importance of disability associated with common mental disorders, research on the detection of mental disorders in primary care has scarcely explored its relevance. Aims To describe the disability burden of primary care patients with common mental disorders and subthreshold disorders and to examine the association between general practitioner's (GP) recognition of mental disorder and disability. Design Cross-sectional survey of GPs and their patients. Setting General practices in the lower North Island of New Zealand. Method Participants were randomly selected: GPs (n=70) and their patients (n=3414, of whom a subset of 775 from the basis of this paper). Formal DSM-IV diagnoses were made with the Composite International Diagnostic Interview (CIDI), and psychosomatic and psychological symptoms were measured with the Somatic and Psychological Health Report. Disability was measured with the World Health Organisation's Disability Assessment Schedule-version II. GPs independently rated the severity of psychological symptoms and the presence or absence of disorder. Results The principal findings were (1) that disability was associated with both mental disorder and subthreshold disorder with no significant difference in the level of disability between these categories, and (2) that GPs were less sensitive to the presence of mental disorders as defined by the CIDI if there was little concomitant disability, and in subthreshold cases, the presence of disability increased the chance of GPs identifying clinically significant symptoms. Conclusion Studies of GP recognition of mental disorder have almost exclusively adopted the perspective of concepts of disorder as defined by psychiatry. This study provides some insight into the way GPs attend to both symptoms and functioning in their assessments of psychological syndromes. Disability is an important cue to recognition of mental health problems in the primary care setting, including those that are not recognised by standardised psychiatric assessment but which may still be relevant to patient suffering.

The Sesto Fiorentino study: point and one-year prevalences of psychiatric disorders in an Italian community sample using clinical interviewers

BACKGROUND

It has been argued that lay interviewers' use of fully-structured interviews could lead to a diagnostic pattern different to that by treating physicians. Clinical interviewers in community samples should probably identify cases that are closer to those seen in clinical settings. The greatest advantage of using clinical interviewers consists of the immediate assessment of a possible psychopathology, i.e. the evaluation of current disorders.

METHODS

Two thousand three hundred and sixty-three citizens from the community of Sesto Fiorentino, Italy, were interviewed by their own general practitioners using the Mini International Neuropsychiatric Interview (MINI). Positive cases for any lifetime psychiatric disorder as well as a random sample of the negative cases were re-interviewed by psychiatrists or trained residents in psychiatry using the Florence Psychiatric Interview (FPI).

RESULTS

The point prevalence for any current disorder was 8.7%; the two disorders with the highest prevalence were generalised anxiety disorder (2.9%) and major depressive episode (2.7%). The figures increase about 50% when the sub-threshold sequelae of previous disorders are considered. Current comorbidity was generally high. The one-year prevalence of any disorder was 10.6%. Ninety-two percent of the cases sought help, 82% were being treated at the moment of interview. Social impairment was considerable.

CONCLUSIONS

The period prevalence rates for most of the disorders considered were generally comparable with the range defined by previous studies conducted in other Western countries, despite using different methodologies. Conversely, the use of health facilities, the treatment received and the social impairment were much higher than those reported by the other studies, suggesting a greater similarity with the clinical samples.

Levels of disability in major depression: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

BACKGROUND

Information on the distribution of disability associated with major depression (MD) across different groups of patients is of interest to health policy and planning. We examined the associations of severity and type (a single or recurrent episode) of MD with disability in a Dutch general population sample.

METHODS

We used data from the first wave (1996) of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). MD 'severity' and 'type' were diagnosed with the help of the Composite International Diagnostic Interview according to DSM-III-R criteria. SF-36 scores, days ill in bed and days absent from work were taken as indicators of disability. The differences in these variables were studied by means of variance and regression analysis.

RESULTS

Recurrent MD was found not to be associated with more disability than single episode MD. Higher 'severity' classes were associated with more disability. However, the degree of disability between 'moderate' and 'severe' MD differed only very slightly. The difference in disability between non-depressed and mildly depressed individuals had a larger effect than between each successive pair of 'severity' classes.

CONCLUSIONS

Three groups of MD can be distinguished based on the associated degree of disability: 'mild', 'moderate to severe' and 'severe with psychotic features'. In the future, these groups can be used to describe the distribution of disability in the depressed population. The marked difference between 'mild' MD and no MD suggests that 'mild' cases should be considered relevant.