Ps. Wang et al., Recent core of common mental disorders in the United States - Prevalence and conformance with evidence-based recommendations, J GEN INT M, 15(5), 2000, pp. 284-292
OBJECTIVE: To relate the presence of recent mental disorders to use of ment
al health services.
DESIGN: Cross-sectional survey.
STUDY POPULATION: The study population was 3,032 respondents to the Midlife
Development in the United States (MIDUS) survey, a nationally representati
ve telephone-and-mail survey conducted in 1996. Twelve-month diagnoses acco
rding to the Diagnostic and Statistical Manual of Mental Disorders, Revised
, Third Edition, of major depressive episode, panic disorder, generalized a
nxiety disorder, and serious mental illness were made using a structured as
sessment. Information was obtained on 12-month treatment for mental health
problems in the general medical, mental health specialty. human services, a
nd self-help sectors. Definitions of treatments consistent with evidence-ba
sed recommendations were developed using available practice guidelines.
MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving
any mental health care and guideline-concordant care were measured. Althoug
h 53.8% of respondents with at least one 12-month mental disorder received
any mental health care in the previous year, only 14.3% received care that
could be considered consistent with evidence-based treatment recommendation
s. Even among those with the most serious and impairing mental illness, onl
y 25% received guideline-concordant treatment. Predictors of receiving guid
eline-concordant care included being white, female, severely ill, and havin
g mental, health insurance coverage.
CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders e
xists in the United States, especially among vulnerable groups such as Afri
can Americans and the underinsured. Cost-effective interventions are needed
to improve both access to and quality of treatment.