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Results From the National Comorbidity Survey Replication

Philip S. Wang, MD, DrPH; Michael Lane, MS; Mark Olfson, MD, MPH; Harold A. Pincus, MD; Kenneth B. Wells, MD, MPH; Ronald C. Kessler, PhD

Arch Gen Psychiatry. 2005;62:629-640.

Background  Dramatic changes have occurred in mental health treatments during the past decade. Data on recent treatment patterns are needed to estimate the unmet need for services.

Objective  To provide data on patterns and predictors of 12-month mental health treatment in the United States from the recently completed National Comorbidity Survey Replication.

Design and Setting  Nationally representative face-to-face household survey using a fully structured diagnostic interview, the World Health Organization’s World Mental Health Survey Initiative version of the Composite International Diagnostic Interview, carried out between February 5, 2001, and April 7, 2003.

Participants  A total of 9282 English-speaking respondents 18 years and older.

Main Outcome Measures  Proportions of respondents with 12-month DSM-IV anxiety, mood, impulse control, and substance disorders who received treatment in the 12 months before the interview in any of 4 service sectors (specialty mental health, general medical, human services, and complementary and alternative medicine). Number of visits and proportion of patients who received minimally adequate treatment were also assessed.

Results  Of 12-month cases, 41.1% received some treatment in the past 12 months, including 12.3% treated by a psychiatrist, 16.0% treated by a nonpsychiatrist mental health specialist, 22.8% treated by a general medical provider, 8.1% treated by a human services provider, and 6.8% treated by a complementary and alternative medical provider (treatment could be received by >1 source). Overall, cases treated in the mental health specialty sector received more visits (median, 7.4) than those treated in the general medical sector (median, 1.7). More patients in specialty than general medical treatment also received treatment that exceeded a minimal threshold of adequacy (48.3% vs 12.7%). Unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial-ethnic minorities, those with low incomes, those without insurance, and residents of rural areas.

Conclusions  Most people with mental disorders in the United States remain either untreated or poorly treated. Interventions are needed to enhance treatment initiation and quality.

Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Wang and Kessler and Mr Lane); Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School (Dr Wang); New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York (Dr Olfson); University of Pittsburgh, Pittsburgh, Pa (Dr Pincus); and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Dr Wells).

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