Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations.
OBJECTIVE
To relate the presence of recent mental disorders to use of mental health services.


METHODS
Cross-sectional survey.


METHODS
The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines.


RESULTS
Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage.


CONCLUSIONS
An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.
Wang
P S
PS
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Berglund
P
P
Kessler
R C
RC
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000628:therapy*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D014481:United States / Q000453:epidemiology