Common Mental Disorder Diagnosis and Need for Treatment are Not the Same: Findings from the NEMESIS Study

Wang, Yunqiao; Henriksen, Christine; Have, Margreet ten; Graaf, Ron de; Stein, Murray B.; Enns, Murray W.; Sareen, Jitender

doi:10.1007/s10488-016-0745-2

Cited by 19 publications

(26 citation statements)

References 32 publications

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“…Heterogeneity of study designs and outcome definitions were large and hampered statistical analysis. Recent naturalistic long-term outcome studies comparing ADM-treated and untreated individuals with diagnosed depression consistently corroborate the findings of Hughes and Cohen's review (Bockting, Hollon, Jarrett, Kuyken, & Dobson, 2015;Hengartner, Angst, & Roessler, 2018;Nuijen, ten Have, Tuithof, van Dorsselaer, & van Bon-Martens, 2014;Verduijn et al, 2017;Vittengl, 2017;Wang et al, 2017). Statistical adjustment for confounders (e.g.…”

Section: Psychological Medicinesupporting

confidence: 66%

“…In contrast, two major reviews of adult depression in general practice and the community (20 studies of almost 6000 participants, most with 3-7 years follow-ups) found that although 10-17% had a chronic course, up to 85% recovered for some time and that 35-60% experienced stable recovery (Steinert et al, 2014;van Weel-Baumgarten et al, 2000). Regarding outcome of non-treated community and general practice cases, multiple studies suggest that many depressive episodes (80-50%) are self-limiting as they remit within 3-12 months (Goldberg, Privett, Ustun, Simon, & Linden, 1998;Regier et al, 1998;Sareen et al, 2013;Spijker et al, 2002;Wang et al, 2017;Whiteford et al, 2013). For instance, Whiteford's (2013) metaanalysis of 19 studies of untreated depression in general practice settings estimated that 23% remit within 3 months, 32% within 6 months, and 53% within 12 months.…”

Section: Naturalistic Long-term Outcome Studiesmentioning

confidence: 99%

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The antidepressant standoff: why it continues and how to resolve it

et al. 2019

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BackgroundAntidepressant medications (ADMs) are widely used and long-term use is increasing. Given this extensive use and recommendation of ADMs in guidelines, one would expect ADMs to be universally considered effective. Surprisingly, that is not the case; fierce debate on their benefits and harms continues. This editorial seeks to understand why the controversy continues and how consensus can be achieved.Methods‘Position’ paper. Critical analysis and synthesis of relevant literature.ResultsAdvocates point at ADMs impressive effect size (number needed to treat, NNT = 6–8) in acute phase treatment and continuation/maintenance ADM treatment prevention relapse/recurrence in acute phase ADM responders (NNT = 3–4). Critics point at the limited clinically significant surplus value of ADMs relative to placebo and argue that effectiveness is overstated. We identified multiple factors that fuel the controversy: certainty of evidence is low to moderate; modest efficacy on top of strong placebo effects allows critics to focus on small net efficacy and advocates on large gross efficacy; ADM withdrawal symptoms masquerade as relapse/recurrence; lack of association between ADM treatment and long-term outcome in observational databases. Similar problems affect psychological treatments as well, but less so. We recommend four approaches to resolve the controversy: (1) placebo-controlled trials with relevant long-term outcome assessments, (2) inventive analyses of observational databases, (3) patient cohort studies including effect moderators to improve personalized treatment, and (4) psychological treatments as universal first-line treatment step.ConclusionsGiven the public health significance of depression and increased long-term ADM usage, new approaches are needed to resolve the controversy.

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Section: Psychological Medicinesupporting

confidence: 66%

Section: Naturalistic Long-term Outcome Studiesmentioning

confidence: 99%

The antidepressant standoff: why it continues and how to resolve it

et al. 2019

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“…Although the expected differences in mental well-being between non-care-seekers and care-seekers, and insu cient care-perceivers and su cient care-perceivers, were observed at T1, we found no differences at T2. This result is in line with previous studies showing that the majority of those with common mental disorders who do not seek treatment remit (33,43,44). Results from a longitudinal study on men and women showed that among persons with untreated depression, anxiety or substance disorder, 50% remitted within three years (43).…”

Section: No Persistent Differences In Mental Well-being At T2supporting

confidence: 91%

Refraining from Seeking Mental Healthcare and Poorer Mental Well-Being: A Longitudinal Population-Based study on Men in Sweden

Olsson

Burström

Hensing

et al. 2020

Preprint

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Background: Depression and anxiety disorder contribute to a significant part of the disease burden among men, yet many men refrain from seeking care or receive insufficient care when they do seek it. This is plausibly detrimental to men’s mental well-being, but there is a lack of population-based research to confirm this. This study investigated 1) if men who had refrained from seeking mental healthcare had poorer mental well-being than those who sought care, 2) if those who sought care but perceived it as insufficient had poorer mental well-being than those who perceived care as sufficient, and 3) if these differences persisted over time. Methods: This longitudinal study used questionnaire data from a population-based sample of 1240 men, aged 19-64 years, in Sweden. Having refrained from seeking mental healthcare, or perceiving the care as insufficient, at any time in life, was assessed in a questionnaire, 2008. Current mental well-being was assessed in both 2008 and 2009 using mean scores on the WHO (Ten) Well-being Index, with a lower score indicating poorer mental well-being. Group differences were calculated using t-tests and multivariable linear regression analysis.Results: Of the men who had perceived a need for mental healthcare, 37% refrained from seeking such care. They had lower mental well-being scores in 2008, compared to those who sought care. Of those seeking care, 29 % perceived it as insufficient. They had lower mental well-being scores in 2008, compared to those who perceived the care as sufficient, but this was not statistically significant when controlling for potential confounders in the regression analysis. There were no differences in mental well-being scores based on care-seeking or perceived care-sufficiency in 2009. Conclusions: This population-based study provides some empirical support for the hypothesis that refraining from seeking mental healthcare, or perceiving the care as insufficient, is detrimental to men’s mental well-being. However, the lack of persistent differences contradicts this hypothesis. The results highlight the need for more research, using larger population-based samples of men, and longer follow-up periods. This should be combined with efforts to increase men’s mental healthcare-seeking and to provide mental healthcare that is perceived as sufficient.

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“…They show that, similar to other high income countries, only 20% of those afflicted with a mental disorder in Germany utilize the health care system [ 5 , 6 ]. Up to 50% of untreated common mental disorders can remit spontaneously within a year [ 7 , 8 ]. This questions the call for early interventions, as it might be a good strategy for some individuals [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Up to 50% of untreated common mental disorders can remit spontaneously within a year [ 7 , 8 ]. This questions the call for early interventions, as it might be a good strategy for some individuals [ 7 ]. However, affected individuals often experience social damage, like worsening of the social climate among colleagues or with supervisors due to reduced work performance [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

Rothermund

Michaelis

Jarczok

et al. 2018

IJERPH

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Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% (n = 133) among occupational health physicians, 14% (n = 136) among primary care physicians and 27% (n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level.

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Common Mental Disorder Diagnosis and Need for Treatment are Not the Same: Findings from the NEMESIS Study

Cited by 19 publications

References 32 publications

The antidepressant standoff: why it continues and how to resolve it

The antidepressant standoff: why it continues and how to resolve it

Refraining from Seeking Mental Healthcare and Poorer Mental Well-Being: A Longitudinal Population-Based study on Men in Sweden

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

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