Hello, my name is Ramin Mojtabai. I'm an associate professor in the department of mental health and I'm a mental health services researcher. I also want to welcome you to our fifth lecture in this course. In this lecture I will be talking about unmet need for care for depression, barriers to care, and programs to improve access to care. So more specifically, in the first section of this lecture I will be talking about the patterns of mental health treatment seeking for depression, especially in the United States. I will also talk about socio-demographic factors that influence treatment seeking. In the second section of the lecture, I will briefly discuss barriers to treatment seeking, including stigma, which is an important barrier. At the end, I will talk about some programs and policies which are aimed at overcoming these barriers. I should say here that although most of the data I will be referring to come from the United States. Because I work and do research in this country. Many of the findings may apply to other industrialized countries and even developing countries. In this section I'll be talking about, unmet need for care and also a little bit about patterns of treatment seeking. A major finding in most of the past research in depression and indeed many are there common mental disorders. Such as anxiety disorders, is that individuals with these disorders either do not seek treatment at all or seek treatment after long delays. This phenomenon is often referred to as a treatment gap, or unmet need for care. I should clarify here that when I talk about seeking treatment in this lecture, I'm talking about asking and receiving help from professionals. Which includes mental health specialists such as psychiatrists, psychologists, social workers, counselors, or they could be general medical providers such as primary care doctors, other medical doctors, and nurses. Also priests, clergy, peer counselors, and alternative medicine providers are sometimes included among professional providers. Many people with depression or other mental health problems seek and receive help from their family or friends. This is a major source of support, and very important. Especially where professional providers may not be easily accessible. However, this informal source of care is not the topic of this lecture. This pie chart is based on data from individuals with a past year history of major depressive episodes in the United States general population. About 62% of these individuals reported having had at least one treatment contact. Whereas about 38% reported that they had not received any treatment in the past year. It's important to note that more than one in four of the individuals who experienced the depressive episodes do not feel the need for treatment. This lack of perceived need is a major barrier to treatment seeking. This graph from a study by Philip Wang, and his colleagues shows the delays in treatment seeking among individuals with major depressive episodes. Bipolar disorder and disthymia in the community. On the horizontal axis timing years since the onset of disorder is shown, and on the vertical axis the probability of having had a treatment contact is shown. As you can see it takes several years after the onset of depression before half of the people with major depression. Or any of these other mood disorders make their first contact. Ten years after the onset of depression, only about 65% of those with major depressive episodes have made a first contact. So you can see, there's often a long delay in seeking treatment among people with major depression. An important finding in research in treatment seeking for depression and other common mental disorders is that social and demographic factors influence treatment seeking. In other words, there is a social selection process going on that influences treatment seeking. Knowing factors that influence social selection can help us to understand why people do not seek treatment, or how we can improve treatment seeking by targeting specific population groups. There is indeed a large body of literature under various factors associated with treatment seeking in depression, other common mental disorders. And we are not going to review this literature. But here I'm going to mention a few of these factors that have consistently been shown to be associated with treatment seeking. One important factor is sex. In most studies in industrialized country settings, men with depression and other common mental disorders are less likely than women to seek treatment. Age is another factor that has been shown in past research to be associated with treatment seeking. Younger adults, by which I mean those who are in late teens, or early 20's, and in some studies, older adults, by which again, I mean people who are 65 years old or older, are less likely then adults who are between these two extremes of age to seek treatment. Another set of factors that has been shown in many studies to be associated with treatment seeking are cultural factors and race and ethnicity. Cultural factors are especially prominent in comparisons across countries. For example, treatment seeking for depression is more common in industrialized countries compared to developing countries. Racial and ethnic variations can happen within a country, as well as between countries. For example, minority racial ethnic groups within the United States are typically less likely to seek and receive depression treatment than the majority whites. We will see soon when we discuss barriers that some of the barriers to treatment seeking are more prominent in some population groups versus others. This ends our first section of the lecture. In the next section, we will discuss barriers to care and solutions to ov-, overcome these barriers.
