title: What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).
abstract: BACKGROUND
  Depression is generally regarded as a serious, incapacitating illness. Although effective treatment strategies are available, timely recognition remains a stumbling block. We investigated the rates of health service uptake among depressed people and the specific depressive symptoms associated with service use, after adjustment for other illness characteristics and sociodemographic variables.
  
  
  METHODS
  In a representative sample (n=7076) of the Dutch adult population, we identified 1572 subjects with lifetime major or minor depression, using the Composite International Diagnostic Interview.
  
  
  RESULTS
  The majority (73%) of subjects with depression had sought specialised mental health care, or to a lesser extent primary care. As expected, those with more severe (vegetative), complex (anxiety-comorbid) or dangerous symptoms (suicidal ideation) were more likely to be treated in the specialised mental health sector. However, subjects with comorbid substance use dependence were less likely to receive care, especially primary care, and those with more education were more likely to receive specialised care, even after adjustment for illness characteristics.
  
  
  CONCLUSIONS
  The use of lifetime measures of depression and service use may have introduced slight recall bias, but it made the assessments less vulnerable to selection bias for chronic cases and to misclassification of subjects with some lifetime treatment experience.
  
  
  CONCLUSIONS
  Although care for people with depression is readily accessible in the Netherlands, people with less education and people with comorbid substance use dependence remain unnecessarily out of reach of the care services. Primary care services need to be strengthened to enable the broad-scale application of stepped-care strategies.
authors.affiliation: Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands. mhave@trimbos.nl
authors.forename: Margreet
authors.initials: M
authors.lastname: ten Have
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Wilma
authors.initials: W
authors.lastname: Vollebergh
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012494:Sampling Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires