Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication.
OBJECTIVE
General medical (GM) treatments for mental health disorders are less likely than specialty mental health (SMH) treatments to be adequate. We explored whether differences in the clinical characteristics of patients treated in each sector (GM-only or SMH-only) or in both sectors (GM+SMH) may help to explain this finding.


METHODS
We analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 English-speaking adult household residents that was carried out in 2001-2003. The NCS-R used a fully structured diagnostic interview to assess DSM-IV disorders, including mood, anxiety, impulse control and substance use disorders. We classified disorders in terms of a three-category severity gradient (serious, moderate and mild) based on information about clinically significant distress and role impairment. We collected self-report data on chronic physical conditions, sociodemographics and type of treatment received for emotional and substance use problems in the 12 months before the interview.


RESULTS
Patients who received GM+SMH treatment had more severe mental disorders and a higher prevalence of mood and anxiety disorders than patients who received treatment in only one of the two sectors. Patients seen in the GM-only and GM+SMH sectors had more chronic physical conditions than patients seen in the SMH-only sector.


CONCLUSIONS
Patient characteristics may partially explain the lower intensity and adequacy of GM treatment.
Uebelacker
Lisa A
LA
Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, RI 02906, USA. lisa_uebelacker@brown.edu <lisa_uebelacker@brown.edu>
Wang
Philip S
PS
Berglund
Patricia
P
Kessler
Ronald C
RC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D002908:Chronic Disease / Q000453:epidemiology* / Q000534:rehabilitation; D003131:Combined Modality Therapy; D015897:Comorbidity; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D014481:United States