Factors associated with health service utilisation for common mental disorders: a systematic review

Abstract

BackgroundThere is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC).MethodsWe searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using “best fit framework synthesis”, with reference to the Andersen socio-behavioural model.ResultsFifty two studies met inclusion criteria. 46 (88%) were from HIC.Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies.Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported.Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services.There was a lack of research from LMIC and on contextual level factors.ConclusionIn HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that “treatment gap” statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors.Trial registrationPROSPERO registration number: 42016046551.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1837-1) contains supplementary material, which is available to authorized users.

Health care use and treatment-seeking for depression symptoms in rural India: A descriptive cross-sectional analysis

“…Intriguingly, the gender differences often reported in studies from high-income countries were not replicated in this setting, and we found the opposite association between marital status and treatment-seeking that which is typically reported elsewhere (6,7,64). This demonstrates the importance of local data in identifying vulnerable groups for service planning, and provides suggestive evidence that processes believed to inhibit treatment-seeking in other cultural contextssuch as masculine ideals of self-sufficiency (65, 66) -may not apply in the same way to Indian populations.…”

“…Thirdly, the evidence did not support an association between treatment-seeking and disability or perceived need for health care, which is at odds with international evidence (7). In light of the high rates of general health service use, this may be because people with depression consider themselves to have other health problems, and attribute their disability and associated need for health care to these non-depression symptoms.…”

The changes of gut microbiota in drug-naïve first-episode MDD patients under treatment by SSRIs

“…The 60 local subjects, including 30 depressed patients and 30 normal subjects, were recruited in this study. The inclusion criteria for subjects described as follows: (1) Age was between 18-65 years old; (2) Body mass index (BMI) was between 18-28 Kg / m 2 ; (3) No history of treatment with antipsychotic medication; (4) Duration of symptoms was between 1 to 24 months; (5) No history of treatment with antidepressant medication; (6) Currently in the acute episode with the Hamilton Depression Rating Scale for Depression (HAMD) score ≥ 24; (7) Other mental disorders such as axis І, personality disorder and mental retardation were excluded; (8) Psychotropic drugs were never used; (9) Diagnosis of depression in Patients group was made by two psychiatrists according to the Mini-International Neuropsychiatric Interview (MINI) [18]; (10) In Controls group, a diagnosis of mental disorder was excluded by two psychiatrists according to the MINI, and HAMD-17 score was < 7; (11) Patients group was de ned as Follow-up group after receiving the drug treatment.…”

“…In addition, a series of exclusion criteria, based on the previous work, were employed in this study to exclude the factors affecting gut microbiota [19]. Those include: (1) No somatic diseases known to affect the gut microbiota such as in ammatory bowel disease, immune system diseases, diabetes, etc. ; (2) Without antibiotics, probiotics or microbiological products used in recent 3 months; (3) Without the history of medical examination or surgery through the gastrointestinal tract in recent 6 months; (4) Without obvious changes in dietary habits or the presence of obvious diarrhea, constipation and other symptoms in recent 1 month.…”

Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

“…Attitudinal barriers, such as preferring to manage problems on one's own, are generally more likely to be endorsed than structural barriers (18,24,27,28). Another reason on the demand-side for not seeking professional care is a low perceived need (27)(28)(29)(30). As can be expected, people with less disabling symptoms are least likely to seek help, but more worrying is that also a considerable amount of people with a severe mental health disorder do not perceive any need for mental health care (27,28,30).…”