Lecture 5A: Patterns of Service Use

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From the course by Johns Hopkins University

Major Depression in the Population: A Public Health Approach

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Johns Hopkins University

Major Depression in the Population: A Public Health Approach

138 ratings

Public Mental Health is the application of the principles of medicine and social science to prevent the occurrence of mental and behavioral disorders and to promote mental health of the population. This course illustrates the principles of public health applied to depressive disorder, including principles of epidemiology, transcultural psychiatry, health services research, and prevention. It is predicted that by 2020 depressive disorder will be the most important cause of disease burden in the entire world! Every human being suffers from feeling depressed at some point or other, but only about one fifth of the population will experience an episode of depressive disorder over the course of their lives. This course illuminates the public health approach to disease, and the particular complexities of applying this approach to mental disorders, using depression as the exemplar.

From the lesson

Unmet Need for Care, Barriers, and Programs to Improve Access

In this module, we discuss unmet need for treatment and treatment seeking and present a public health view of depression treatment.

Lecture 5A: Patterns of Service Use6:31

Lecture 5B: Barriers and Solutions14:47

Meet the Instructors

William Eaton, PhD
Professor, Mental Health
Bloomberg School of Public Health
Wietse A. Tol, PhD
Ali & Rose Kawi Assistant Professor, Mental Health
Bloomberg School of Public Health
Ramin Mojtabai, MD
Associate Professor, Mental Health
Bloomberg School of Public Health

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.

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