title: Time Preferences, Mental Health and Treatment Utilization.
abstract: BACKGROUND
  In all countries of the world, fewer than half of people with mental disorders receive treatment. This treatment gap is commonly attributed to factors such as consumers' limited knowledge, negative attitudes, and financial constraints. In the context of other health behaviors, such as diet and exercise, behavioral economists have emphasized time preferences and procrastination as additional barriers. These factors might also be relevant to mental health.
  
  
  OBJECTIVE
  We examine conceptually and empirically how lack of help-seeking for mental health conditions might be related to time preferences and procrastination.
  
  
  METHODS
  Our conceptual discussion explores how the interrelationships between time preferences and mental health treatment utilization could fit into basic microeconomic theory. The empirical analysis uses survey data of student populations from 12 colleges and universities in 2011 (the Healthy Minds Study, N=8,806). Using standard brief measures of discounting, procrastination, and mental health (depression and anxiety symptoms), we examine the conditional correlations between indicators of present-orientation (discount rate and procrastination) and mental health symptoms.
  
  
  RESULTS
  The conceptual discussion reveals a number of potential relationships that would be useful to examine empirically. In the empirical analysis depression is significantly associated with procrastination and discounting. Treatment utilization is significantly associated with procrastination but not discounting.
  
  
  CONCLUSIONS
  The empirical results are generally consistent with the idea that depression increases present orientation (reduces future orientation), as measured by discounting and procrastination. These analyses have notable limitations that will require further examination in future research: the measures are simple and brief, and the estimates may be biased from true causal effects because of omitted variables and reverse causality. There are several possibilities for future research, including: (i) observational, longitudinal studies with detailed data on mental health, time preferences, and help-seeking; (ii) experimental studies that examine immediate or short-term responses and connections between these variables; (iii) randomized trials of mental health therapies that include outcome measures of time preferences and procrastination; and, (iv) intervention studies that test strategies to influence help-seeking by addressing time preferences and present orientation.
authors.affiliation: University of Michigan, M3517 SPH II, 1415 Washington Heights, Dept. of Health Management and Policy, School of Public Health, Ann Arbor, MI 48109-2029, USA, daneis@umich.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eisenberg
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D013334:Students; D013997:Time Factors; D014495:Universities; D055815:Young Adult