|
Mediating Factors of Treatment Seeking
for Depression
Tables 1, 2,
and 3 provide an overview of mediating
factors and their associated significance. According to the literature,
factors that seem most likely to increase treatment seeking are
middle-to-older-adult age and the “young elderly” age
range of 59 to about 72 years (4,10,12–15); white ethnicity
(10,15); enhanced social supports including more contacts, better
quality relationships, and more recommendations from friends and
family to seek help (9,10,16); increased number of depressive symptoms
(1,3,4,6,10,12,13,15); more associated functional impairment (2,6,9,13);
increased current or recent comorbid psychiatric disorders, especially
anxiety disorders (2,5,6,13,15); longer durations of depressive
episodes (9,10,13,16); and previous help for emotional problems
(9,14,16). Symptoms of suicidal ideation (9,13), sleep disturbance
(9,13,16), cognitive changes such as slowed thinking and poor concentration
(9,13,17), and depressed appetite or weight (13,17) also urge individuals
to seek treatment for depression.
Discussion
This paper intended to review the literature to determine an approximate
rate at which individuals seek treatment when they are depressed.
This review revealed a wide overall range of estimated rates of
treatment seeking (between 17.0% and 77.8%). In this review, we
have attempted to identify the sources of variation across these
studies. Many studies used different measures of depression and
treatment and assessed different time periods of treatment seeking.
Likewise, some studies incorporated retrospective and self-report
parameters among their measures for depression and treatment seeking.
Finally, rates varied according to the study’s publication
year. For these reasons, this review could not identify a single
“best estimate” of treatment-seeking rates; rather, we
identified a range of rates based on different definitions and measurement
strategies.
Despite the heterogeneity in this literature, we drew 3 noteworthy
conclusions. First, treatment seeking rates for major depression
appear to be increasing over the years. This overall increase in
rates of treatment seeking may reflect the positive influences of
public education and screening, as well as improved detection of
depression by professionals. Second, several studies (1,6,12,15)
demonstrated that treatment-seeking is not limited to individuals
who meet full assessment or diagnostic criteria for a depressive
episode. Finally, the mediating factors of age, ethnicity, social
supports, and clinical or psychiatric factors appear to be most
influential in urging affected individuals to seek treatment.
Of the 17 studies reviewed, only 3 included Canadian results. These
studies deserve emphasis, because they provide data and insights
that are especially pertinent to the Canadian population. Of the
3 studies, 2 provided overall treatment-seeking rates for major
depression (2,5) (46.7% [5] and 48.9% [2]). Both rates were based
on 1-year treatment-seeking intervals. Parikh and others (11) further
subdivided a previous study’s sample into urban and rural groups
(2). No significant differences were observed between urban and
rural treatment-seeking rates. Of the mediating factors these Canadian
studies assessed (2,5,11), the following were found to significantly
increase treatment-seeking rates for depression: female sex, increased
associated functional impairment, and comorbid psychiatric disorders.
The search strategy employed in this review did not uncover one
Canadian study (18). Nevertheless, this study also highlights some
relevant Canadian data. Galbaud du Fort and others reported lifetime
treatment-seeking rates of 69.0% for those with major depression
(18), 59.0% for those with a depressive illness in association with
bereavement, and 57.0% for those with dysthymia or a depressive
illness, not meeting diagnostic criteria. Further, they found that
the following factors significantly increased the likelihood of
treatment seeking: psychomotor retardation, suicidal ideation, comorbid
mania, comorbid panic disorder, female sex, an older age at first
onset of the depressive illness, and a longer exposure to the illness.
They also found comorbid drug abuse or dependence to reduce the
likelihood for treatment seeking (18).
Although depression is generally responsive to treatment, it continues
to carry a huge cost for both affected individuals and society at
large. This review found evidence suggesting that treatment-seeking
rates for major depression are increasing over time. However, the
rates appear to be lower for young adults, “old elderly,”
nonwhites, and those lacking social support. Various clinical or
psychiatric factors also appear to influence treatment seeking rates.
Public health initiatives aimed at increasing treatment seeking
should consider targeting these groups. Further, Canadian studies
that gauge treatment-seeking rates for depression will help to monitor
these trends and progress in Canada.
Funding and Support
This project was supported by grant 6609-09-1999/2640029 from the
Canadian National Health Research and Development Program (NHRDP).
Acknowledgements
The authors wish to thank Emily McKenzie, and Dr Li Feng Xiao,
for their work in conducting blinded critical appraisals of studies
for this literature review.
References
1. Beekman AT, Deeg DJ, Braam AW, Smit JH, van Tilburg
W. Consequences of major and minor depression in later life: a study
of disability, well-being and service utilization. Psychol Med 1997;27:1397–409.
2. Parikh SV, Lesage AD, Kennedy SH, Goering PN. Depression
in Ontario: under-treatment and factors related to antidepressant
use. J Affect Disord 1999;52:67–76.
3. Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression
in the community: the first pan-European study DEPRES (Depression
Research in European Society). Int Clin Psychopharmacol 1997;12:19–29.
4. Romans-Clarkson SE, Walton VA, Dons DJ, Mullen PE.
Which women seek help for their psychiatric problems? N Z Med J
1990;103:445–8.
5. Bland RC, Newman SC, Orn H. Help-seeking for psychiatric
disorders. Can J Psychiatry 1997;42:935–42.
6. Lewinsohn PM, Rohde P, Seeley JR. Treatment of adolescent
depression: frequency of services and impact on functioning in young
adulthood. Depress Anxiety 1998;7:47–52.
7. Angst J, Merikangas K. The depressive spectrum:
diagnostic classification and course. J Affect Disord 1997;45:31–9.
8. Bebbington PE, Marsden L, Brewin CR. The need for
psychiatric treatment in the general population: The Camberwell
Needs for Care Survey. Psychol Med 1997;27:821–34.
9. Dew MA, Bromet EJ, Schulberg HC, Parkinson DK, Curtis
EC. Factors affecting service utilization for depression in a white
collar population. Soc Psychiatry Psychiatr Epidemiol 1991;26:230–7.
10. Sussman LK, Robins LN, Earls F. Treatment-seeking
for depression by black and white Americans. Soc Sci Med 1987;24:187–96.
11. Parikh SV, Wasylenki D, Goering P, Wong J. Mood
disorders: rural/urban differences in prevalence, health care utilization,
and disability in Ontario. J Affect Disord 1996;38(1):57–65.
12. Rokke PD, Klenow DJ. Prevalence of depressive symptoms
among rural elderly: examining the need for mental health services.
Psychotherapy 1998;35:545–58.
13. Coryell W, Endicott J, Winokur G, Akiskal H, Solomon
D, Leon A, and others. Characteristics and significance of untreated
major depressive disorder. Am J Psychiatry 1995;152:1124–9.
14. Blanchard MR, Waterreus A, Mann AH. The nature
of depression among older people in inner London, and the contact
with primary care. Br J Psychiatry 1994;164:396–402.
15. Olfson M, Klerman GL. Depressive symptoms and mental
health service utilization in a community sample. Soc Psychiatry
Psychiatr Epidemiol 1992;27:161–7.
16. ew MA, Dunn LO, Bromet EJ, Schulberg HC. Factors
affecting help-seeking during depression in a community sample.
J Affect Disord 1988;14:223–34.
17. Bucholz KK, Robins LN. Who talks to a doctor about
existing depressive illness? J Affect Disord 1987;12:241–50.
18.Galbaud du Fort G, Newman SC, Boothroyd LJ, Bland
RC. Treatment seeking for depression: role of depressive symptoms
and comorbid psychiatric diagnoses. J Affect Disord 1999;52:31–40.
--------------------------------------------------------------------------------
Manuscript received October 2001, revised April 2002, and accepted
May 2002.
1 Psychiatry Resident, Faculty of Medicine, University of Calgary,
Calgary, Alberta.
2 Associate Professor, Departments of Community Health Sciences
and Psychiatry, Faculty of Medicine, University of Calgary, Calgary,
Alberta; Population Health Investigator, The Alberta Heritage Foundation
for Medical Research, Calgary, Alberta.
Address for correspondence: Dr SB Patten, Departments of Community
Health Sciences and Psychiatry, Faculty of Medicine, University
of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1
e-mail: patten@ucalgary.ca
1
| 2 | 3
|
