The Relation between Perceived Need for Mental Health Treatment, DSM Diagnosis, and Quality of Life: A Canadian Population-Based Survey

Abstract

Objectives: Prevalence estimates of mental disorders were designed to provide an indirect estimate of the need for mental health services in the community. However, recent studies have demonstrated that meeting criteria for a DSM-based disorder does not necessarily equate with need for treatment. The current investigation examined the relation between self-perceived need for mental health treatment and DSM diagnosis, with respect to quality of life (QoL) and suicidal ideation. Methods: Data came from an Ontario population-based sample of 8116 residents (aged 15 to 64 years). The University of Michigan Composite International Diagnostic Interview was used to diagnose mood, anxiety, substance use, and bulimia disorder according to DSM-III-R criteria. We categorized past-year help seeking for emotional symptoms and (or) perceiving a need for treatment without seeking care as self-perceived need for treatment. We used a range of variables to measure QoL: self-perception of mental health status, a validated instrument that measured well-being, and restriction of activities (current, past 30 days, and long-term). Results: Independent of subjects' meeting criteria for a DSM-III-R diagnosis, self-perceived need for treatment was significantly associated with poor QoL (on all measures) and past-year suicidal ideation. Conclusions: Self-perceived need for mental health treatment, in addition to DSM diagnosis, may provide valuable information for estimating the number of people in the population who need mental health services. The relation between self-perceived need for treatment and objective measures of treatment need requires future study.

Perceived Need for Mental Health Treatment in a Nationally Representative Canadian Sample

“…Previous studies have identified self-perceived need for treatment when respondents have either endorsed a need for mental health treatment or sought professional treatment (12,(24)(25)(26)(27). Cross-national surveys assessing perceived need for treatment have found the following results.…”

“…From these findings, some leaders in the field of psychiatric epidemiology have suggested that a large proportion of individuals diagnosed with mental disorders may suffer from transient or mild symptoms that do not require treatment (5,6). Conversely, community surveys have repeatedly demonstrated that a significant proportion of individuals seek or perceive a need for treatment without meeting criteria for a mental disorder (12)(13)(14)(15). These individuals could have a past mental disorder, a subthreshold mental disorder (16)(17)(18)(19)(20), or a disorder that was not assessed in the survey.…”

“…These individuals could have a past mental disorder, a subthreshold mental disorder (16)(17)(18)(19)(20), or a disorder that was not assessed in the survey. Previous work suggests that these individuals could also benefit from treatment (12,21). In short, the presence of a DSM diagnosis is not a good measure of the need for treatment (5).…”

“…Increased attention has also recently been paid to selfperceived need for mental health treatment in the community (12,(24)(25)(26)(27)(28). This concept takes into account theoretical models of HS.…”

“…In considering these stages of HS, it becomes apparent that defining how many people in the community need mental health treatment depends on which stage of this HS process is used as the threshold to determine need. Our group and others have suggested that, when assessing how many people need help for emotional symptoms, it might be useful to examine self-perceived need for mental health treatment in addition to assessing who meets criteria for a mental disorder diagnosis (12,26,29).…”