Reasons and determinants of help-seeking in people with a subclinical depression.

BACKGROUND Subclinical depression is common. Although interventions have proven to be effective, participation rates are low. This study first aimed to get more insight in help-seeking and reasons for (not) seeking care. The second aim was to identify characteristics that distinguish people who receive help, those with an unmet need, or no perceived need for care. METHODS Respondents with a subclinical depression (n=162) were recruited from the general population. They were eligible for participation if they were aged 18 years or older, scored 20 or higher on the K10 screening instrument for depression, and did not meet the criteria for major depression. RESULTS Of all participants, 27% received help, 33% had an unmet need, and 40% had no perceived need for care. Participants with no perceived need reported not to experience symptoms, were able to solve problems on their own, and could mobilize their own support. They were characterized by lower scores on neuroticism and an older age than those who received care. LIMITATIONS The response rate in this study was relatively low which may have caused a selection bias. CONCLUSION Not all people with subclinical depression may need help for their symptoms, some are able to deal with problems on their own. However, others experience a need for care but do not receive any. Gaining insight into potential barriers for help seeking and receiving in people with an unmet need is important so appropriate measures can be taken to ensure that those who need care get the help they want.

[1]  J. Lépine,et al.  The European Study of the Epidemiology of Mental Disorders (ESEMeD) project: an epidemiological basis for informing mental health policies in Europe , 2004, Acta psychiatrica Scandinavica. Supplementum.

[2]  R. Kessler,et al.  Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. , 1997, Journal of affective disorders.

[3]  H Orn,et al.  Help-Seeking for Psychiatric Disorders , 1997, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[4]  M. Stein,et al.  Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands , 2007 .

[5]  C. Mackenzie,et al.  Age, gender, and the underutilization of mental health services: The influence of help-seeking attitudes , 2006, Aging & mental health.

[6]  R. Andersen.  Revisiting the behavioral model and access to medical care: does it matter? , 1995, Journal of health and social behavior.

[7]  D. Goldberg,et al.  Plato versus Aristotle: categorical and dimensional models for common mental disorders. , 2000, Comprehensive psychiatry.

[8]  W. Eaton,et al.  Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. , 1995, The American journal of psychiatry.

[9]  J. Anderson.  Demographic Factors Affecting Health Services Utilization: A Causal Model , 1973, Medical care.

[10]  P. Cuijpers,et al.  Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. , 2014, International journal of epidemiology.

[11]  J. Ormel,et al.  Does neuroticism explain variations in care service use for mental health problems in the general population? , 2005, Social Psychiatry and Psychiatric Epidemiology.

[12]  M. Trivedi,et al.  Exercise treatment for depression: efficacy and dose response. , 2005, American journal of preventive medicine.

[13]  L. George,et al.  Depression, disability days, and days lost from work in a prospective epidemiologic survey. , 1990, JAMA.

[14]  J. Ayuso-Mateos,et al.  Definitions and factors associated with subthreshold depressive conditions: a systematic review , 2012, BMC Psychiatry.

[15]  J. Anthony,et al.  Filters on the pathway to mental health care, II. Sociodemographic factors , 1995, Psychological Medicine.

[16]  Dan J Stein,et al.  Barriers to mental health treatment: results from the WHO World Mental Health surveys , 2013, Psychological Medicine.

[17]  L. Burns,et al.  Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being. , 2002, Drug and alcohol dependence.

[18]  P. Costa,et al.  NEO inventories for the NEO Personality Inventory-3 (NEO-PI-3), NEO Five-Factor Inventory-3 (NEO-FFI-3), NEO Personality Inventory-Revised (NEO PI-R) : professional manual , 2010 .

[19]  Herbert Matschinger,et al.  The stigma of psychiatric treatment and help-seeking intentions for depression , 2009, European Archives of Psychiatry and Clinical Neuroscience.

[20]  J. Bensing,et al.  Receiving treatment for common mental disorders. , 2009, General hospital psychiatry.

[21]  J. Ayuso-Mateos,et al.  Subclinical depression in Spain: prevalence and health impact. , 2011, Revista de psiquiatria y salud mental.

[22]  R. Kessler,et al.  Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project , 2004, Acta psychiatrica Scandinavica. Supplementum.

[23]  S. Patten,et al.  Treatment-Seeking Rates and Associated Mediating Factors among Individuals with Depression , 2002, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[24]  S. Bartels.  Improving the United States' System of Care for Older Adults With Mental Illness: Findings and Recommendations for The President's New Freedom Commission on Mental Health , 2003 .

[25]  G. Andrews,et al.  The psychometric properties of the Composite International Diagnostic Interview , 1998, Social Psychiatry and Psychiatric Epidemiology.

[26]  P. Farrand,et al.  ‘I am not a depressed person’: How identity conflict affects help-seeking rates for major depressive disorder , 2012, BMC Psychiatry.

[27]  M. Tansella,et al.  Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. , 2003, Journal of affective disorders.

[28]  R. de Graaf,et al.  What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). , 2004, Journal of affective disorders.

[29]  H. Christensen,et al.  Predictors of depression stigma , 2008, BMC psychiatry.

[30]  R. de Graaf,et al.  Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders , 2009, Social Psychiatry and Psychiatric Epidemiology.

[31]  J. Angst,et al.  Which individuals with affective symptoms seek help? Results from the Zurich epidemiological study , 2003, Acta psychiatrica Scandinavica.

[32]  P. Cuijpers,et al.  Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies , 2004, Acta psychiatrica Scandinavica.

[33]  L. Pearlin,et al.  The structure of coping. , 1978, Journal of health and social behavior.

[34]  M. Carter.  Diagnostic and Statistical Manual of Mental Disorders, 5th ed. , 2014 .

[35]  A. Farmer,et al.  The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. , 1988, Archives of general psychiatry.

[36]  Samuel Juni,et al.  Revised NEO personality inventory , 1995 .

[37]  Filip Smit,et al.  Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. , 2008, The American journal of psychiatry.

[38]  B. Geiselmann,et al.  Subthreshold depression in the elderly: qualitative or quantitative distinction? , 2000, Comprehensive psychiatry.

[39]  G. Andrews,et al.  Shortfall in mental health service utilisation , 2001, British Journal of Psychiatry.

[40]  Kathleen M Griffiths,et al.  Stigma about Depression and its Impact on Help-Seeking Intentions , 2006, The Australian and New Zealand journal of psychiatry.

[41]  H. Christensen,et al.  Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review , 2010, BMC psychiatry.

[42]  Richard Fielding,et al.  The differential mediating effects of pain and depression on the physical and mental dimension of quality of life in Hong Kong Chinese adults , 2010, Health and quality of life outcomes.

[43]  Anne W. Taylor,et al.  Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population , 2004, Social Psychiatry and Psychiatric Epidemiology.

[44]  J. Endicott,et al.  Barriers to seeking treatment for major depression , 1996, Depression and anxiety.

[45]  T. T. Haug,et al.  The validity of the Hospital Anxiety and Depression Scale. An updated literature review. , 2002, Journal of psychosomatic research.

[46]  J. Suvisaari,et al.  DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population , 2005, Social Psychiatry and Psychiatric Epidemiology.

[47]  Anthony F Jorm,et al.  Who Uses Mental Health Services in Australia? An Analysis of Data from the National Survey of Mental Health and Wellbeing , 2000 .

[48]  R. Mojtabai.  Unmet need for treatment of major depression in the United States. , 2009, Psychiatric services.

[49]  Elizabeth L. Ogburn,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. , 2007, Archives of general psychiatry.

[50]  L. Roijen,et al.  Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness , 2002 .

[51]  Asko Tolvanen,et al.  Personal stigma and use of mental health services among people with depression in a general population in Finland , 2011, BMC psychiatry.

[52]  P. Cuijpers,et al.  Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. , 2004, Journal of affective disorders.

[53]  R. Andersen,et al.  Societal and individual determinants of medical care utilization in the United States. , 1973, The Milbank Memorial Fund quarterly. Health and society.

[54]  P. Salkovskis,et al.  Help-seeking for depression: The role of beliefs, attitudes and mood , 2007 .

[55]  D. Gunnell,et al.  Help-seeking behaviour in men and women with common mental health problems: cross-sectional study , 2005, British Journal of Psychiatry.

[56]  L. Judd,et al.  Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. , 1998, Journal of affective disorders.

[57]  S. Bartels.  Improving the System of Care for Older Adults With Mental Illness in the United States. , 2003 .

[58]  R. Kessler,et al.  Short screening scales to monitor population prevalences and trends in non-specific psychological distress , 2002, Psychological Medicine.

[59]  Martin J Buxton,et al.  A review of health utilities using the EQ-5D in studies of cardiovascular disease , 2010, Health and quality of life outcomes.

[60]  P. Cuijpers,et al.  The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders , 2010, Psychiatry Research.

[61]  R. Kessler,et al.  The use of complementary and alternative therapies to treat anxiety and depression in the United States. , 2001, The American journal of psychiatry.

[62]  G. Bonsel,et al.  Test-retest reliability of health state valuations collected with the EuroQol questionnaire. , 1994, Social science & medicine.

[63]  Birgit Babitsch,et al.  Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011 , 2012, Psycho-social medicine.