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Articles   |    
Lifetime Treatment Contact and Delay in Treatment Seeking After First Onset of a Mental Disorder
Margreet ten Have, Ph.D.; Ron de Graaf, Ph.D.; Saskia van Dorsselaer, M.Sc.; Aartjan Beekman, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200454
View Author and Article Information

With the exception of Dr. Beekman, the authors are affiliated with the Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, Utrecht 3500 AS, the Netherlands (e-mail: mhave@trimbos.nl). Dr. Beekman is with the Department of Psychiatry and the EMGO Institute, VU University Medical Center, Amsterdam.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study examined lifetime treatment contact and delays in treatment seeking, including rates for receipt of helpful treatment, after the onset of specific mental disorders and evaluated factors that predicted treatment seeking and delays in treatment seeking.

Methods  Data were from the Netherlands Mental Health Survey and Incidence Study−2, a nationally representative, face-to-face survey of the general population aged 18–64 (N=6,646). DSM-IV diagnoses, treatment contact, and respondents' perception of treatment helpfulness were assessed with the Composite International Diagnostic Interview 3.0.

Results  The proportion of respondents with lifetime mental disorders who made lifetime treatment contact ranged from 6.5% to 56.5% for substance use disorders and from 75.3% to 91.4% for mood disorders. Delays in initial treatment contact varied among persons with mood disorders (median=0 years), substance use disorders (0–4 years), impulse-control disorders (4–8 years), and anxiety disorders (0–19 years). The proportion of respondents who received helpful treatment ranged from 33.5% for substance use disorders to 69.5% for mood disorders. Men, older cohorts, and respondents with younger age at onset of the disorder generally were more likely to have no lifetime treatment contact, to have longer treatment delay, and to have not received helpful treatment.

Conclusions  There was substantial variation in lifetime treatment contact and delays in initial treatment contact by mental disorder. Lifetime treatment contact, delays in treatment seeking, and receipt of helpful treatment did not vary by educational level.

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Table 1Lifetime treatment contacts for mental disorders among survey participants, by contacts before or after disorder onseta
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a Numbers of participants are unweighted, but percentages, means, and medians are weighted.

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b Treatment delay is expressed as years between disorder onset and initial treatment contact. Delay was set at zero years for persons with initial treatment contact before disorder onset or in the year of disorder onset.

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c Measured for respondents aged 18–44 only

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Table 2Predictors of lifetime treatment contact for mental disorders, in adjusted hazard ratios (AHRs)a
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a AHRs are weighted and adjusted for all variables in the table.

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Table 3Predictors of treatment delay after disorder onset among persons with lifetime treatment contacta
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a Treatment delay is expressed as weighted mean additional years of delay between disorder onset and initial treatment contact compared with a reference group, adjusted for all variables in the table.

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Table 4Receipt of lifetime helpful treatment for mental disorders, by receipt in or after year of initial treatment contacta
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a Numbers of persons are unweighted, but percentages, means, and medians are weighted.

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b Helpful treatment delay is expressed as years between initial treatment contact and first receipt of helpful treatment. Delay was set at zero years for persons who received helpful treatment in the year of initial treatment contact.

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Table 5Predictors of lifetime helpful treatment and delay of helpful treatment for any mental disorder, in adjusted hazard ratios (AHRs)a
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a AHRs are weighted and adjusted for all variables in the table.

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b Weighted mean additional years between initial treatment contact and first receipt of helpful treatment compared with a reference group, adjusted for all variables in the table.

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