Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study

Understanding components and predictors of delay of first treatment for mental health problems: A hospital-based study in China

BACKGROUND

Understanding components and predictors of delay of first treatment for mental health problems are crucial to inform interventions for earlier treatment. However, Chinese-context knowledge of this theme is still limited.

METHODS

We conducted an inpatient survey among 206 patients with various mental disorders in China. Delay of first utilization of mental healthcare (Delay-Total) and its two components of help-seeking delay (Delay-H) and referral delay (Delay-R) were assessed in terms of occurrence and duration. Binary logistic regression was performed to test predictors of Delay-Total, Delay-H and Delay-R, and multiple linear regression was used to test predictors of delay durations.

RESULTS

Overall, 66.0% patients experienced Delay-Total, with a duration range of 0 to 353 months; 49.5% patients had Delay-H (duration range = 0-207 months) and 29.6% with Delay-R (duration range = 0-323 months). Multivariate logistic regression analysis found that the diagnosis of severe mental disorders was a consistent predictor for a reduced chance of Delay-Total, Delay-H and Delay-R. Multiple linear regression analysis demonstrated that younger age of disorder onset and disorder onset before 2016 were significantly associated with longer delay.

CONCLUSIONS

Delay of first treatment for mental health problems is still common in China. However, the development of mental health policy and services promotes shorter treatment delay. The diagnosis of common mental disorders and younger age of onset are risk factors of the occurrence and duration of delay, respectively. Thus, education of the public and non-mental-healthcare professionals are needed for better disorder recognition and more efforts should be inputted to support youngsters' utilization of mental healthcare.

Experiences of seeking and accessing medical care among persons with major depression: A qualitative descriptive study of persons with depression in China

INTRODUCTION

A large number of people in China are affected by depression, yet tend to delay seeking treatment. This study aims to explore persons living with depression and their journey of diagnoses and seeking professional medical help in China.

METHODS

Semi-structured interviews were conducted with 20 persons who visiting physicians to be diagnosed and receive professional help from a large mental health center in Guangzhou, Guangdong province, China. Individual interviews were conducted and data were analyzed using content analysis.

RESULTS

Three themes were identified from the findings: (1) "noticed something was wrong"; (2) negotiated decisions with their own narratives and the personal suggestions of others; and (3) gave new meaning to their experiences of depression, whereby they sought medical treatment.

DISCUSSION

The findings of the study indicated that the impact of progressive depressive symptoms on the participants' daily lives was a strong motivation for them to seek professional help. The obligation to care for and support their family prevented them from initially disclosing their depressive symptoms to family members, but eventually prompted them to seek professional help and persist in follow-up treatment. Some participants experienced unexpected benefits (e.g., relief at no longer feeling "alone") during their first visit to the hospital for depression or when they were diagnosed with depression. The results suggest a need to continue to actively screen for depression and provide more public education to prevent negative assumptions and reduce public and personal stigmatization of those with mental health problems.

Student Counseling Centers in Europe: A Retrospective Analysis

Objective

Tertiary education can be stressful for many young people, who consistently report high levels of distress. The issue has major implications for campus health services and mental health policymaking more widely. The present study proposes to map student counseling services in Europe.

Methods

The sample of institutions was sourced, using standardized data extraction, from the European Tertiary Education Register (ETER). Then, each institution's website was analyzed for information about the availability of student counseling centers and the services provided. Data extracted from the ETER database were: ETER ID, national identifier, institution name, English institution name, number of students, legal status (in English), institution category (in English), and institutional website. Data extracted from institutions' websites concerned the availability of students' psychological centers and the services provided. Analyses were carried out using the SPSS Statistics software package (IBM Corp., Armonk, NY, United States), version 26.

Results

Overall, it was found that most institutions do not provide mental health counseling services for their students. Institutions of medium dimensions showed a higher probability of reporting students' psychological centers than small institutions. Moreover, private institutions and public institutions were more likely to report having such centers, while private government-dependent institutions were less likely. Universities of applied sciences and universities were more likely to report having them, while other institutions were less likely. Regarding provision according to geographic area, compared to Northern Europe, every other European region was less likely to report featuring such centers. Most institutions reported offering counseling, career counseling, or not otherwise specified psychological services, but only a small number reported providing services such as psychotherapy, psychiatric services, or counseling for learning-specific disabilities.

Conclusion

It is critically important to catalog European data on student counseling centers and services, to encourage tertiary education institutions to invest in such services as key sites for mental health promotion. Indeed, professionally trained staff and the possibility of long-term treatment options would go a long way in supporting students who might not otherwise have access to treatment.

Duration of untreated illness of patients with obsessive-compulsive disorder in Japan

AIM

Obsessive-compulsive disorder (OCD) is a common and severe disease; however, the duration of untreated illness (DUI) of OCD is approximately 7 years, which is longer than that of other psychiatric disorders. Differences in medical environments have been reported to affect the DUI. Therefore, we surveyed the DUI of OCD in Japan and the reason for delayed treatment.

METHODS

The study participants were outpatients who visited the OCD specialty outpatient clinic for the first time between June 1, 2017 and May 31, 2019. Obsessive-compulsive disorder was diagnosed using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and semistructured clinical interviews, which included asking the reason for the delay in seeking treatment and treatment drop-out history.

RESULTS

Seventy-one patients met the inclusion criteria for the study. The mean period between OCD and the first visit to the hospital was 2.8 years and the mean DUI of OCD was 4.7 years. There was a significant difference in the history of tic disorders and treatment drop out between patients with a DUI of >2 years and those with a DUI of ≤2 years. The most common reason for delaying treatment was that the patient did not consider the symptoms of OCD to be those of an illness, and the most common reason for dropping out of treatment was lack of improvement.

CONCLUSIONS

This was the first study on the DUI of OCD in Japan. The DUI was relatively shorter than that found by studies in other countries. Stopping treatment lengthened the duration of the illness. Preventing the patient from dropping out of treatment could further shorten the duration of the illness.

Factors that influence psychiatric help-seeking behavior in Japanese university students

We investigated the periods from symptom onset to the first visit to the psychiatric consultation and the factors that influence psychiatric help-seeking behavior in university students. Students who first visited the psychiatric department of university health care center were the study participants. We surveyed the elicited information such as age, sex, period from symptom onset to the first visit, main symptoms, General Health Questionnaire GHQ-12, and perception of stigma associated with receiving a psychiatric consultation. We analyzed the factors affecting the duration until a psychiatric consultation was made using logistic regression analysis, examining age, sex, contents of the problem, GHQ-12, and stigma as independent variables. Of the participants, 48.2 % did not consult with a psychiatrist for more than 6 months and 51 participants (36.7 %) took more than a year before a consultation. We divided the study participants into two groups: early examinees and delayed examinees. In order to investigate the factors affecting the two groups, logistic regression analysis was performed. Of the independent variables, one consultation content (physical symptoms; odds ratio (OR) = 9.21, 95 % CI (confidence interval) = 2.00-42.62, p = 0.004) and the GHQ-12 (OR = 1.17, 95 % CI = 1.05-1.31, p = 0.005) were significant factors. It became clear that physical symptoms significantly accelerated consultation with psychiatry. When various problems occurred, the decision to seek a psychiatry consultation required a long time. Health education focusing on the values of seeking an early consultation is required so that when students have mental health problems they will seek psychiatric services in a timely manner.

Factors and help-seeking behaviors associated with depression in Korean adults: Review of data from 2014 and 2016 Korea national health and nutrition examination surveys

As a health problem in Korea, the prevalence of depression is continuously increasing. This study examines factors and help-seeking behaviors associated with depression in Korean adults. Data was extracted from Korea National Health and Nutrition Examination Surveys (2014 and 2016) using the PHQ-9 depression screening instrument. Among 10,459 participants (weighted frequency = 36,418,292) over 19 years old, 7.2% were classified as having depression including depressive symptoms (PHQ-9 scores ≥ 10) or depressive disorders diagnosed by psychiatrists. Among those with depression, 58.6% responded that they had never sought help. Statistically high odds ratios for being at risk for depression include being female, aged 19-39, living alone, low household income, low level of education (middle school or lower), occupation (unemployed/inactive), an ex- or current smoker, having a chronic disease, and being underweight. Statistically low odds ratios for seeking counselling, age ≥ 60 and lower than high household income; for seeing doctor, age 19-39 or ≥60; and for treatment, age 19-39, lower than middle household income, and more than once per week drinking frequency. Overall, there is a need to find persons having these risk factors and to develop tailored strategies that will encourage help-seeking behavior with help-seeking intention.

Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness

BACKGROUND

Previous investigation on the duration of untreated illness (DUI) in patients with Major Depressive Disorder (MDD) revealed a different latency to first antidepressant treatment, with adverse consequences in terms of outcome for individuals with a longer DUI. Recent reports, moreover, documented a reduced DUI, as observed with the passage of time, in patients with different psychiatric disorders. Hence, the present study was aimed to assess DUI and related variables in a sample of Italian patients with MDD as well as to investigate potential differences in subjects with onset before and after 2000.

METHODS

An overall sample of 188 patients with MDD was assessed through a specific questionnaire investigating DUI and other variables related to the psychopathological onset and latency to first antidepressant treatment, after dividing them in two different subgroups on the basis of their epoch of onset.

RESULTS

The whole sample showed a mean DUI of approximately 4.5 years, with patients with more recent onset showing a significantly shorter latency to treatment compared with the other group (27.1±42.6 vs 75.8±105.2 months, P<.05). Other significant differences emerged between the two subgroups, in terms of rates of onset-related stressful events and benzodiazepine prescription, respectively, higher and lower in patients with more recent onset.

CONCLUSIONS

Our findings indicate a significant DUI reduction in MDD patients whose onset occurred after vs before 2000, along with other relevant differences in terms of onset-related correlates and first pharmacotherapy. Further studies with larger samples are warranted to confirm the present findings in Italy and other countries.