Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study

Abstract

OBJECTIVES: This study examined the use of primary health care, mental health care, and informal care services, as well as unmet care needs, by individuals with different psychiatric diagnoses. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study and were based on a representative sample (n = 7147) of the general population (aged 18-64 years). RESULTS: In a 12-month period, 33.9% of those with a psychiatric disorder used some form of care; 27.2% used primary care, and 15.3% used mental health care. Patients with mood disorders were the most likely to enlist professional care; those with alcohol- and drug-related disorders were the least likely to do so. Higher educated persons who live alone, single parents, unemployed persons, and disabled persons were more likely to use mental health care. Unmet need for professional help was reported by 16.8% (men 9.9%, women 23.9%) of those with a disorder. CONCLUSIONS: Care use varies widely by diagnostic category. The role of general medical practitioners in treating persons with psychiatric disorders is more limited than was anticipated. Patients in categories associated with extensive use of professional care are more likely to have unmet care needs.

Social determinants of mental health service utilization in Switzerland

“…Education was not a significant predictor in the present study, which differs from research in other countries (Bijl and Ravelli 2000;Kovess-Masfety et al 2007;Parslow and Jorm 2000;Schomerus et al 2012;Wang et al 2007). …”

“…Other researchers also found lower utilization rates among those with substance use relative to those with mood problems (Angst et al 2005;Bijl and Ravelli 2000;Burgess et al 2009;Kohn et al 2004;Kovess-Masfety et al 2007;Reavley et al 2010;Rhodes et al 2002), possibly because the former less often perceived a need for treatment (Mojtabai et al 2002) and more often believed that treatment would be of limited value (Rhodes et al 2002;ten Have et al 2010). Furthermore, stigma and shame have also been identified as a major reason for not seeking treatment among those with problematic alcohol use (Probst et al 2015).…”

“…Similarly, a US study found that people who were employed were less likely to access primary or speciality care relative to unemployed respondents (Lo and Cheng 2012), and a study from the Netherlands found higher utilization rates among unemployed (vs. employed) people (Bijl and Ravelli 2000). People who (almost) work full-time might have more difficulties in arranging appointments with mental health professionals during working hours (Lo and Cheng 2012).…”

“…Furthermore, stigma and shame have also been identified as a major reason for not seeking treatment among those with problematic alcohol use (Probst et al 2015). Lastly, it is possible that risky alcohol consumption is tolerated to a large extent in the Swiss and other Western societies and that only a prolonged problematic consumption leads to negative reactions of the social environment and a realization that professional help is needed (Bijl and Ravelli 2000).…”

“…Need factors, such as having a diagnosed mental disorder or suffering from more severe mental health problems, have indeed been identified as the most important predictors of utilization in different countries (e.g., Burns et al 2003;Leaf et al 1988;Parslow and Jorm 2000;Schomerus et al 2012). However, predisposing and enabling factors -such as female gender (Angst et al 2005;Bijl et al 2003;Bovier et al 2001;Burgess et al 2009;Fleury et al 2014;Wang et al 2007), higher educational level (Bijl and Ravelli 2000;Kovess-Masfety et al 2007;Parslow and Jorm 2000;Schomerus et al 2012;Wang et al 2007), more positive attitudes towards help-seeking (ten Have et al 2010) and having health insurance (e.g., Garfield et al 2011) -have repeatedly been shown to increase the likelihood of using mental health services even after adjusting for need.…”