Understanding mental health treatment in persons without mental diagnoses: results from the National Comorbidity Survey Replication.
BACKGROUND
Epidemiologic surveys have consistently found that approximately half of respondents who obtained treatment for mental or substance use disorders in the year before interview did not meet the criteria for any of the disorders assessed in the survey. Concerns have been raised that this pattern might represent evidence of misallocation of treatment resources.


OBJECTIVE
To examine patterns and correlates of 12-month treatment of mental health or substance use problems among people who do not have a 12-month DSM-IV disorder.


METHODS
Data are from the National Comorbidity Survey Replication, a nationally representative face-to-face US household survey performed between February 5, 2001, and April 7, 2003, that assessed DSM-IV disorders using a fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI).


METHODS
A total of 5692 English-speaking respondents 18 years and older.


METHODS
Patterns of 12-month service use among respondents without any 12-month DSM-IV CIDI disorders.


RESULTS
Of respondents who used 12-month services, 61.2% had a 12-month DSM-IV CIDI diagnosis, 21.1% had a lifetime but not a 12-month diagnosis, and 9.7% had some other indicator of possible need for treatment (subthreshold 12-month disorder, serious 12-month stressor, or lifetime hospitalization). The remaining 8.0% of service users accounted for only 5.6% of all services and even lower proportions of specialty (1.9%-2.4%) and general medical (3.7%) visits compared with higher proportions of human services (18.9%) and complementary and alternative medicine (7.6%) visits. Only 26.5% of the services provided to the 8.0% of presumably low-need patients were delivered in the mental health specialty or general medical sectors.


CONCLUSIONS
Most services provided for emotional or substance use problems in the United States go to people with a 12-month diagnosis or other indicators of need. Patients who lack these indicators of need receive care largely outside the formal health care system.
Druss
Benjamin G
BG
Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. bdruss@emory.edu
Wang
Philip S
PS
Sampson
Nancy A
NA
Olfson
Mark
M
Pincus
Harold A
HA
Wells
Kenneth B
KB
Kessler
Ronald C
RC
D001294:Attitude to Health; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology