Elsevier

Journal of Affective Disorders

Volume 174, 15 March 2015, Pages 556-561
Journal of Affective Disorders

Research report
Trends in psychological distress, depressive episodes and mental health treatment-seeking in the United States: 2001–2012

https://doi.org/10.1016/j.jad.2014.12.039Get rights and content

Highlights

  • The prevalence of past-month significant psychological distress and past-year depressive symptoms in the United States changed little between 2001 and 2012.

  • A larger percentage of participants reported days with poor mental health in more recent years.

  • A larger percentage of participants in the later period also reported receiving mental health treatment.

  • The prevalence of perceived unmet need for mental health care changed little over time.

Abstract

Background

There has been an increase in the use of mental health services in a number of industrialized countries over the past two decades with little impact on mental health status of the populations. Few studies, however, have examined recent trends in mental health status in the US.

Methods

Using data from three large general annual population surveys in the US—the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Survey on Drug Use and Health—we examined temporal trends in non-specific psychological distress, depressive episodes and mental health treatment seeking over the 2001–2012 period.

Results

Prevalence of past-month significant psychological distress and past-year depressive symptoms changed little over time. However, a larger percentage of participants reported poor mental health for ≥15 days or 30 days in the past month in 2011–2012 (8.7% and 5.7%, respectively) than in 2001–2002 (6.6% and 4.6%). A larger percentage of participants in the later period also reported receiving mental health treatments.

Limitations

Possible changes in mental health status may have been missed due to the limited scope of assessments or the small magnitude of changes. Potential reciprocal influences between service use and mental health status could not be investigated because of cross-sectional data.

Conclusions

Despite increasing use of mental health treatments in the US in the first decade of this century, there is no evidence of decrease in prevalence of psychological distress or depression. Poor match between need for treatment and actual treatments received in usual care settings may partly explain the findings.

Introduction

The use of mental health services, in general, and psychiatric medications, in particular, dramatically increased in the United States in 1990s (Kessler et al., 2005, Mojtabai, 2008, Paulose-Ram et al., 2007). Yet there is no evidence that the prevalence of mental disorders declined over this same period (Kessler et al., 2003b, Kessler et al., 2005). Indeed, one study based on two large national surveys, the National Longitudinal Alcohol Epidemiologic Survey and the National Epidemiologic Survey on Alcohol and Related Conditions, found a more than two-fold increase in the prevalence of major depressive episodes between 1991–1992 and 2001–2002 (Compton et al., 2006). Other studies based on the National Comorbidity Survey of 1991–1992 and National Comorbidity Survey-Replication of 2001–2003 found essentially similar prevalence of 12-month depression and other common mental disorders in this period (Kessler et al., 2003b, Kessler et al., 2005). Nevertheless, these authors and others have noted significant increases in mental health treatment seeking (Kessler et al., 2005, Olfson et al., 2002, Zuvekas, 2001). and especially psychiatric medications in this period (Mojtabai, 2008). Similar results have been reported from other industrialized countries (Brugha et al., 2004, Jorm, 2014a, Jorm, 2014b, Jorm and Reavley, 2012, Mojtabai, 2011b, Patten and Beck, 2004). These trends are indeed puzzling and raise questions about the effectiveness of mental health treatments and the public health impact of campaigns aimed at increasing treatment seeking (Jorm, 2014b).

Much of the past research on trends in psychiatric disorder, distress and mental health treatment seeking in the US has explored these trends in the 1990s. Less is known about trends in more recent years. There is some evidence that the increasing trend in antidepressant medication use in the US may have slowed down and any increase in prevalence of use in the first decade of the century may be attributed to an increase in long-term use of these medications (Mojtabai and Olfson, 2014). There is also some evidence of increase in prevalence of self-reported mental health disability in more recent years (Mojtabai, 2011a). However, trends in mental health service use in general and psychological distress need to be further examined.

In this study, we used data from multiple nationally representative population surveys to examine trends in psychological distress and depressive symptoms in the US adult population between 2001 and 2012. We further assessed trends in treatment seeking and perceived unmet need for mental health treatment in this period. This study builds on past research by extending the years covered to the first decade of the 21st century. The study also improves upon past research by using data from large annual surveys that employed the same measures each year.

Section snippets

Samples

Data were drawn from 3 annual national surveys: the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and the National Survey on Drug Use and Health (NSDUH). NHIS is an annual, cross-sectional survey of the non-institutionalized US population conducted by the National Center for Health Statistics (Pleis et al., 2009). The survey is comprised of a family interview with a knowledgeable adult informant regarding each family member. In addition, a

Psychological distress

A total of 54,985 (15.1%) of the 349,852 NHIS participants with K6 ratings scored in the ≥5 to <13 range indicating moderate psychological distress. Another 12,207 (3.1%) scored in the ≥13 range indicating severe psychological distress. In unadjusted logistic regression analyses, no significant trends were observed over time (odds ratio [OR]=1.02, 99% CI=.97–1.07, p=.253 for moderate distress and OR=1.05, 99% CI=.96–1.15, p=.161 for severe distress). The results were similar in adjusted models

Discussion

This study recorded modest increases in mental health treatment seeking and the use of psychiatric medications in the US in the first decade of this century. However, we observed few changes in the prevalence of severe or moderate psychological distress, assessed using the K6 measure, in prevalence of depressive symptoms meeting the threshold of a major depressive episode assessed using a structured interview or in perceived unmet need for mental health care. The global assessment of the number

Conflict of interest

Dr. Mojtabai has received consulting fees and research funding from Lundbeck and Bristol-Myers Squibb. Dr. Jorm has no potential conflict of interest.

Role of funding source

This research was not supported by any funding source.

Acknowledgements

None.

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