Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication☆
Received 13 February 2006; accepted 1 May 2006.
Abstract
Objective
General medical (GM) treatments for mental health disorders are less likely than specialty mental health (SMH) treatments to be adequate. We explored whether differences in the clinical characteristics of patients treated in each sector (GM-only or SMH-only) or in both sectors (GM+SMH) may help to explain this finding.
Method
We analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 English-speaking adult household residents that was carried out in 2001–2003. The NCS-R used a fully structured diagnostic interview to assess DSM-IV disorders, including mood, anxiety, impulse control and substance use disorders. We classified disorders in terms of a three-category severity gradient (serious, moderate and mild) based on information about clinically significant distress and role impairment. We collected self-report data on chronic physical conditions, sociodemographics and type of treatment received for emotional and substance use problems in the 12 months before the interview.
Results
Patients who received GM+SMH treatment had more severe mental disorders and a higher prevalence of mood and anxiety disorders than patients who received treatment in only one of the two sectors. Patients seen in the GM-only and GM+SMH sectors had more chronic physical conditions than patients seen in the SMH-only sector.
Conclusion
Patient characteristics may partially explain the lower intensity and adequacy of GM treatment.
aDepartment of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, RI 02906, USA
bDepartment of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
cDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
dInstitute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA
☆ The views and opinions expressed in this report are those of the authors and should not be construed as representing the views of any of the sponsoring organizations/agencies or of the US government. A complete list of National Comorbidity Survey publications and the full text of all National Comorbidity Survey Replication instruments can be found at http://www.hcp.med.harvard.edu/ncs. Please send correspondence to ncs@hcp.med.harvard.edu.
ABSTRACT