Probability and Predictors of First Treatment Contact for Anxiety Disorders in the United States

Iza, Miren; Olfson, Mark; Vermes, Donna; Hoffer, Marcela; Wang, Shuai; Blanco, Carlos

doi:10.4088/jcp.13m08361

Cited by 44 publications

(27 citation statements)

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“…Further, when modeled simultaneously , within-domain multivariate comorbidity level was consistently associated with greater odds of utilizing treatment for that domain, but the association of between-domain multivariate comorbidity level with treatment utilization varied; it is striking that externalizing was associated with significantly decreased odds of anxiety (and any emotional disorder) treatment utilization when controlling for internalizing. This finding partially contradicts previous findings in the NESARC indicating that there was no statistically significant association between SUDs and treatment for GAD, social anxiety, panic disorder, or specific phobia in adjusted models [31]. This highlights the additional information that can be conferred by transdiagnostic comorbidity approaches and within- and between-domain comorbidity considerations.…”

Section: Discussioncontrasting

confidence: 90%

“…To our knowledge, there has been only one attempt to integrate treatment utilization research with findings from latent transdiagnostic comorbidity research [70]. Treatment utilization studies typically focus on individual disorders or on limited (e.g., pair-wise) comorbidity patterns while controlling for presence of other disorders [17, 25, 31, 32]. To these ends, we applied a well-supported latent transdiagnostic factor model to understand how multivariate comorbidity was associated with utilization of treatments for various types of disorders.…”

Section: Discussionmentioning

confidence: 99%

“…However, some anxiety and personality disorders are inversely related to SUD treatment [17], and antisocial personality disorder appears to be a barrier to treatment for anxiety disorders [31]. Given these complexities, examining the effects of comorbidity by considering pairs of individual disorders (the usual approach) may miss important information [33].…”

Section: Introductionmentioning

confidence: 99%

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Mental disorder comorbidity and treatment utilization

Rodriguez‐Seijas

Eaton

Stohl

et al. 2017

Comprehensive Psychiatry

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Objective Effective interventions have been developed for myriad common psychological and substance use disorders, though they remain highly underutilized. Previous research has shown that the likelihood of treatment utilization varies across disorder diagnosis. However, studies that focus on individual disorders have resulted in a large, piecemeal literature that neglects the high rates of multivariate comorbidity. The current study investigated the association between treatment utilization and transdiagnostic comorbidity factors. Method In a nationally representative sample of the United States adult population (N=34,653), we applied the internalizing-externalizing latent comorbidity model to examine its association with lifetime utilization of various treatments for mood, anxiety, and substance use disorders. Results Both internalizing and externalizing transdiagnostic factors were positively associated with all forms of treatment utilization. Stronger within-domain domain (e.g., internalizing’s association with mood or anxiety treatment) than between-domain (e.g., internalizing’s association with substance use disorder treatment) associations were found. Significant antagonistic internalizing-by-externalizing interactions were also observed. Conclusions These results underscore the importance of applying a nuanced approach to modeling comorbidity when predicting treatment utilization. Clinical implications are discussed.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mental disorder comorbidity and treatment utilization

Rodriguez‐Seijas

Eaton

Stohl

et al. 2017

Comprehensive Psychiatry

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“…Compared to cisgender individuals, transgender persons have greater rates of many forms of psychopathology (e.g., (32)), and the presence of co-occurring psychiatric disorders is associated with increased treatment-seeking (36). Moreover, transgender individuals are often required to attend counseling in order to receive gender affirming treatments, increasing their overall rate of interaction with mental health professionals.…”

Section: Discussionmentioning

confidence: 99%

Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students

Diemer¹,

Grant²,

Munn‐Chernoff³

et al. 2015

Journal of Adolescent Health

324

254

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Purpose This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors (CB) in trans- and cis-gender college students. Methods Data came from 289,024 students from 223 U.S. universities participating in The American College Health Association – National College Health Assessment II (median age 20 years). Rates of self-reported past year SR-ED diagnosis and past month use of diet pills and vomiting or laxatives were compared among transgender students (n=479) and cisgender sexual minority male (n=5,977) and female (n=9,445), unsure male (n=1,662) and female (n=3,395), and heterosexual male (n=91,599) and female (n=176,467) students using chi-squared tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates. Results Rates of past year SR-ED diagnosis and past month use of diet pills and vomiting or laxatives were highest among transgender students and lowest cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past year SR-ED diagnosis (OR: 4.62, 95% CI: 3.41-6.26) and past month use of diet pills (OR: 2.05, 95% CI: 1.48-2.83) and vomiting or laxatives (OR: 2.46, 95% CI: 1.83-3.30). Although cisgender sexual minority men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than for transgender individuals (ORs: 1.40-1.54). Conclusions Transgender and cisgender sexual minority young adults have elevated rates of CB and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.

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“…Among those with depression, treatment was more likely among those with substance use disorders [331], while suicidal behavior led to emergency services but not outpatient treatment [337]. Treatment for mood or anxiety disorders was less likely among those with personality disorders, and more likely with anxiety comorbidity [335,338]. Use of emergency and hospital services was elevated among those with personality disorders, even after adjustment for Axis I disorders [339].…”

Section: Major Findingsmentioning

confidence: 99%

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

Hasin

Grant

2015

Soc Psychiatry Psychiatr Epidemiol

386

293

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Purpose The NESARC, a “third generation” psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems, has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. Method NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. Result The most common disorders were alcohol and post-traumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the “gender gap”) is less pronounced than it was in previous decades. A race/ethnic “paradox” (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. Conclusions Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests urgent need for public and professional education to reduce the stigma associated with these disorders, and increase knowledge of treatment options.

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Probability and Predictors of First Treatment Contact for Anxiety Disorders in the United States

Cited by 44 publications

References 0 publications

Mental disorder comorbidity and treatment utilization

Mental disorder comorbidity and treatment utilization

Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

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