0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Service Use and Barriers to Mental Health Care Among Adults With Major Depression and Comorbid Substance Dependence
Lian-Yu Chen, M.D.; Rosa M. Crum, M.D., M.H.S.; Silvia S. Martins, M.D., Ph.D.; Christopher N. Kaufmann, M.H.S.; Eric C. Strain, M.D.; Ramin Mojtabai, M.D., Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200289
View Author and Article Information

With the exception of Dr. Martins and Dr. Strain, all of the authors are affiliated with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, HH784, Baltimore, MD 21205 (e-mail: liachen@jhsph.edu). Dr. Martins is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York City. Dr. Strain is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The study explored mental health service use patterns and barriers to care among individuals with comorbid mental and substance use disorders.

Methods  Using data from the National Survey on Drug Use and Health (2005–2010) for 18,972 adults with past-year major depressive episodes, the study compared mental health service use and perceived barriers to care among participants with and without co-occurring alcohol dependence, nonalcohol drug dependence, and both alcohol and drug dependence.

Results  Compared with participants without comorbid substance dependence, participants with alcohol dependence or both alcohol and nonalcohol drug dependence used more mental health services of all types, and participants with only comorbid alcohol dependence used more medication treatments. Participants with comorbid substance dependence were significantly more likely than those without comorbid substance dependence to report unmet mental health treatment need. However, barriers to mental health care were remarkably similar across groups, with financial barriers being the most common in all groups.

Conclusions  Participants with major depression comorbid with substance dependence used more mental health services but also perceived more unmet need for such care than individuals without such comorbidity. However, barriers to mental health care were similar across groups with and without comorbidity. Policies aimed at expanding insurance coverage and mental health parity would likely benefit individuals with major depression and substance dependence comorbidity even more than those without such comorbidity.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Sociodemographic characteristics of 18,972 adults with past-year major depressive episodes and association with comorbid substance use disordersa
Table Footer Note

a Adults with no comorbidity were the reference group.

Table Footer Note

b Based on self-ratings on the Sheehan Disability Scale for performing household chores, ability to do well at school or work and get along with family, and social life

Table Footer Note

*p<.05, **p<.01, ***p<.001

Anchor for Jump
Table 2Mental health service use among 18,972 adults with past-year major depressive episodes and association with comorbid substance use disorders
Table Footer Note

a Adjusted risk ratios (ARRs) are from multivariate logistic models that controlled for the adults’ age, sex, race-ethnicity, marital status, education, income, insurance, employment, functional impairment, and population density of the area of residence. Adults with no comorbidity were the reference group.

Table Footer Note

*p<.05, **p<.01, ***p<.001

Anchor for Jump
Table 3Barriers to mental health treatment among 6,756 adults with past-year major depressive episodes and with perceived unmet need for mental health treatment and association with comorbid substance use disorders
Table Footer Note

a Adjusted risk ratios (ARRs) are from multivariate logistic models that controlled for adults’ age, sex, race-ethnicity, marital status, education, income, insurance, employment, functional impairment, and population density of the area of residence. Adults with no comorbidity were the reference group.

Table Footer Note

*p<.05, **p<.01, ***p<.001

+

References

Kessler  RC;  McGonagle  KA;  Zhao  S  et al:  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey.  Archives of General Psychiatry 51:8–19, 1994
[CrossRef] | [PubMed]
 
Kessler  RC;  Nelson  CB;  McGonagle  KA  et al:  The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization.  American Journal of Orthopsychiatry 66:17–31, 1996
[CrossRef] | [PubMed]
 
Regier  DA;  Farmer  ME;  Rae  DS  et al:  Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study.  JAMA 264:2511–2518, 1990
[CrossRef] | [PubMed]
 
Kleinman  PH;  Miller  AB;  Millman  RB  et al:  Psychopathology among cocaine abusers entering treatment.  Journal of Nervous and Mental Disease 178:442–447, 1990
[CrossRef] | [PubMed]
 
Grant  BF;  Stinson  FS;  Dawson  DA  et al:  Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Archives of General Psychiatry 61:807–816, 2004
[CrossRef] | [PubMed]
 
Martins  SS;  Gorelick  DA:  Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the US population.  Drug and Alcohol Dependence 119:28–36, 2011
[CrossRef] | [PubMed]
 
Alegría  AA;  Hasin  DS;  Nunes  EV  et al:  Comorbidity of generalized anxiety disorder and substance use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Journal of Clinical Psychiatry 71:1187–1195, quiz 1252–1253, 2010
[CrossRef] | [PubMed]
 
Buckley  PF:  Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness.  Journal of Clinical Psychiatry 67(suppl 7):5–9, 2006
[CrossRef] | [PubMed]
 
Chou  SP;  Lee  HK;  Cho  MJ  et al:  Alcohol use disorders, nicotine dependence, and co-occurring mood and anxiety disorders in the United States and South Korea—a cross-national comparison.  Alcoholism, Clinical and Experimental Research 36:654–662, 2012
[CrossRef] | [PubMed]
 
Harris  KM;  Edlund  MJ:  Use of mental health care and substance abuse treatment among adults with co-occurring disorders.  Psychiatric Services 56:954–959, 2005
[CrossRef] | [PubMed]
 
Kessler  RC;  Berglund  PA;  Bruce  ML  et al:  The prevalence and correlates of untreated serious mental illness.  Health Services Research 36:987–1007, 2001
[PubMed]
 
Kessler  RC;  Crum  RM;  Warner  LA  et al:  Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey.  Archives of General Psychiatry 54:313–321, 1997
[CrossRef] | [PubMed]
 
Kessler  RC;  Zhao  S;  Katz  SJ  et al:  Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey.  American Journal of Psychiatry 156:115–123, 1999
[PubMed]
 
Regier  DA;  Narrow  WE;  Rae  DS  et al:  The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.  Archives of General Psychiatry 50:85–94, 1993
[CrossRef] | [PubMed]
 
Urbanoski  KA;  Rush  BR;  Wild  TC  et al:  Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders.  Psychiatric Services 58:962–969, 2007
[CrossRef] | [PubMed]
 
Wang  PS;  Lane  M;  Olfson  M  et al:  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:629–640, 2005
[CrossRef] | [PubMed]
 
Wu  LT;  Kouzis  AC;  Leaf  PJ:  Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the National Comorbidity Survey.  American Journal of Psychiatry 156:1230–1236, 1999
[PubMed]
 
Compton  WM;  Thomas  YF;  Stinson  FS  et al:  Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Archives of General Psychiatry 64:566–576, 2007
[CrossRef] | [PubMed]
 
Grant  BF;  Dawson  DA:  Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey.  Journal of Substance Abuse 9:103–110, 1997
[CrossRef] | [PubMed]
 
Hasin  DS;  Stinson  FS;  Ogburn  E  et al:  Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Archives of General Psychiatry 64:830–842, 2007
[CrossRef] | [PubMed]
 
Mojtabai  R;  Olfson  M;  Mechanic  D:  Perceived need and help seeking in adults with mood, anxiety, or substance use disorders.  Archives of General Psychiatry 59:77–84, 2002
[CrossRef] | [PubMed]
 
Keyes  KM;  Hasin  DS:  Socioeconomic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis.  Addiction (Abingdon, England) 103:1120–1130, 2008
[CrossRef] | [PubMed]
 
Bijl  RV;  Ravelli  A:  Psychiatric morbidity, service use, and need for care in the general population: results of the Netherlands Mental Health Survey and Incidence Study.  American Journal of Public Health 90:602–607, 2000
[CrossRef] | [PubMed]
 
Grella  CE;  Stein  JA:  Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders.  Psychiatric Services 57:1007–1015, 2006
[CrossRef] | [PubMed]
 
Wu  LT;  Ringwalt  CL;  Williams  CE:  Use of substance abuse treatment services by persons with mental health and substance use problems.  Psychiatric Services 54:363–369, 2003
[CrossRef] | [PubMed]
 
Urbanoski  KA;  Cairney  J;  Bassani  DG  et al:  Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders.  Psychiatric Services 59:283–289, 2008
[CrossRef] | [PubMed]
 
Sareen  J;  Jagdeo  A;  Cox  BJ  et al:  Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands.  Psychiatric Services 58:357–364, 2007
[CrossRef] | [PubMed]
 
Babor  TF;  Caetano  R:  The trouble with alcohol abuse: what are we trying to measure, diagnose, count and prevent? Addiction (Abingdon, England) 103:1057–1059, 2008
[CrossRef] | [PubMed]
 
Mojtabai  R:  Unmet need for treatment of major depression in the United States.  Psychiatric Services 60:297–305, 2009
[CrossRef] | [PubMed]
 
 Results From the 2005 National Survey on Drug Use and Health: National Findings. NSDUH series H-30, DHHS pub no SMA-06-4194 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006
 
 Results From the 2006 National Survey on Drug Use and Health: National Findings. NSDUH series H-32, DHHS pub no SMA 07-4293 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2007
 
 Results From the 2007 National Survey on Drug Use and Health: National Findings. NSDUH series H-34, DHHS pub no SMA 08-4343 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2008
 
 Results From the 2008 National Survey on Drug Use and Health: National Findings. NSDUH series H-36, HHS pub no SMA 09-4434 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2009
 
 Results from the 2009 National Survey on Drug Use and Health , vol 1:  Summary of National Findings. NSDUH series H-38A, HHS pub no SMA 10-4856 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2010
 
 Results From the 2010 National Survey on Drug Use and Health: Summary of National Findings. NSDUH series H-41, HHS pub no SMA 11-4658 .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2011
 
 Diagnostic and Statistical Manual of Mental Disorders , 4th ed.  Washington, DC,  American Psychiatric Association, 1994
 
Brugha  TS;  Jenkins  R;  Taub  N  et al:  A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).  Psychological Medicine 31:1001–1013, 2001
[CrossRef] | [PubMed]
 
Kessler  RC;  Berglund  P;  Demler  O  et al:  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).  JAMA 289:3095–3105, 2003
[CrossRef] | [PubMed]
 
Sheehan  DV;  Harnett-Sheehan  K;  Raj  BA:  The measurement of disability.  International Clinical Psychopharmacology 11(suppl 3):89–95, 1996
[CrossRef] | [PubMed]
 
Oakley Browne  MA;  Wells  JE;  McGee  MA:  Twelve-month and lifetime health service use in Te Rau Hinengaro: the New Zealand Mental Health Survey.  Australian and New Zealand Journal of Psychiatry 40:855–864, 2006
[CrossRef] | [PubMed]
 
Watkins  KE;  Burnam  A;  Kung  FY  et al:  A national survey of care for persons with co-occurring mental and substance use disorders.  Psychiatric Services 52:1062–1068, 2001
[CrossRef] | [PubMed]
 
Mojtabai  R;  Olfson  M;  Sampson  NA  et al:  Barriers to mental health treatment: results from the National Comorbidity Survey Replication.  Psychological Medicine 41:1751–1761, 2011
[CrossRef] | [PubMed]
 
Wells  JE;  Robins  LN;  Bushnell  JA  et al:  Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress.  Social Psychiatry and Psychiatric Epidemiology 29:155–164, 1994
[PubMed]
 
Jobe  JB;  White  AA;  Kelley  CL  et al:  Recall strategies and memory for health care visits.  Milbank Quarterly 68:171–189, 1990
[CrossRef] | [PubMed]
 
Petrou  S;  Murray  L;  Cooper  P  et al:  The accuracy of self-reported health care resource utilization in health economic studies.  International Journal of Technology Assessment in Health Care 18:705–710, 2002
[CrossRef] | [PubMed]
 
Ritter  PL;  Stewart  AL;  Kaymaz  H  et al:  Self-reports of health care utilization compared to provider records.  Journal of Clinical Epidemiology 54:136–141, 2001
[CrossRef] | [PubMed]
 
Wang  J:  Mental health treatment dropout and its correlates in a general population sample.  Medical Care 45:224–229, 2007
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 38.  >
APA Practice Guidelines > Chapter 0.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 3.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 3.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles