A piece of my mind: stigma

Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems

ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly.

METHODS

As part of the MentDis_ICF65+ study, N = 3,142 people aged 65-84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses.

RESULTS

Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. "I can deal with my problem on my own" (90%).

CONCLUSION

Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.

Sociodemographic determinants of attitudinal barriers in the use of mental health services in Japan: findings from the World Mental Health Japan Survey 2002-2006

AIM

Sociodemographic correlates of Japanese attitudinal barriers to mental health services might be different from previous studies in Western countries, reflecting a different culture. We investigated sociodemographic correlates of attitudinal barriers to mental health services in a community population in Japan, based on data collected in the World Mental Health Survey Japan surveys.

METHODS

An interview survey was conducted of a random sample of residents living in 11 communities across Japan during 2002-2006. A total of 1359 participants were analyzed. The variables on attitudinal barriers to mental health services were measured by using the World Health Organization Composite International Diagnostic Interview 3.0. The association between these variables and sociodemographic variables were analyzed by using multiple logistic regressions.

RESULTS

Being male was significantly associated with willingness to go for professional help and feeling comfortable to talk with a professional. Compared to the youngest group (20-34 years old), those aged from 35 to 49 years had a significantly lower prevalence of feeling embarrassed about friends knowing about their getting professional help, while the oldest group (aged over 65 years) had a significantly higher prevalence of being embarrassed. Being currently married was significantly associated with higher expectations about mental health services, but it was significantly and negatively associated with willingness to go for professional help.

CONCLUSION

These results suggest that demographic patterns of attitudinal barriers to mental health services in Japan are unique, compared with previous studies in Western countries. An anti-stigma campaign may need to consider such country-specific patterns in a particular country.

ADHD and health services utilization in the national health interview survey

OBJECTIVE

Describe the general health, comorbidities and health service use among U.S. children with ADHD.

METHOD

The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization.

RESULTS

Asthma was two and headaches were three times more prevalent, and overall health was significantly lower, among children with SDQ ADHD. Of children with SDQ ADHD, 45% saw a mental health professional in the past year and over half were not taking medication regularly. Urban residence, age (9-13), higher family education, having health insurance, and having comorbid emotional problems were associated with mental health care utilization in children with SDQ AD/HD, while race, gender and family income were not associated.

CONCLUSIONS

Children with SDQ AD/HD had more medical problems and were more likely to visit the emergency room. Treatment data suggest a problem with under-treatment of ADHD in the United States. Interventions should be targeted in rural areas, and among families with low education and without health insurance.

Failure to seek health care among the mentally ill

This study describes failure to seek health care among 673 new adult clients seeking mental health services in the San Francisco Bay area. Overall, 49% (n = 328) reported a failure to seek health care they believed was needed in the past year. People with dual diagnosis, severe depression, chronic physical illness, fear of coercive treatment, private insurance, and no insurance were more likely to fail to seek health care. Greater use of private physicians decreased the odds of failure to seek health care. These findings highlight the need to target groups at risk for failure to seek health care and the need to design nonthreatening programs to improve health access for people with mental illness.

General medical considerations in child and adolescent patients who present with psychiatric symptoms

This article has presented a 12-step approach to general medical evaluation in child and adolescent psychiatric emergencies (Box 2). It is hoped that the article, which suggests targeted consideration of key specific issues, will stimulate further interest and work in this area and help optimize child psychiatrists' ability to exclude general medical conditions and work effectively with colleagues in providing children and families with safe medical care.