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Results From the National Comorbidity Survey Replication

Benjamin G. Druss, MD, MPH; Philip S. Wang, MD, DrPH; Nancy A. Sampson, BA; Mark Olfson, MD, MPH; Harold A. Pincus, MD; Kenneth B. Wells, MD, MPH; Ronald C. Kessler, PhD

Arch Gen Psychiatry. 2007;64(10):1196-1203.

Context  Epidemiologic surveys have consistently found that approximately half of respondents who obtained treatment for mental or substance use disorders in the year before interview did not meet the criteria for any of the disorders assessed in the survey. Concerns have been raised that this pattern might represent evidence of misallocation of treatment resources.

Objective  To examine patterns and correlates of 12-month treatment of mental health or substance use problems among people who do not have a 12-month DSM-IV disorder.

Design and Setting  Data are from the National Comorbidity Survey Replication, a nationally representative face-to-face US household survey performed between February 5, 2001, and April 7, 2003, that assessed DSM-IV disorders using a fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI).

Participants  A total of 5692 English-speaking respondents 18 years and older.

Main Outcome Measures  Patterns of 12-month service use among respondents without any 12-month DSM-IV CIDI disorders.

Results  Of respondents who used 12-month services, 61.2% had a 12-month DSM-IV CIDI diagnosis, 21.1% had a lifetime but not a 12-month diagnosis, and 9.7% had some other indicator of possible need for treatment (subthreshold 12-month disorder, serious 12-month stressor, or lifetime hospitalization). The remaining 8.0% of service users accounted for only 5.6% of all services and even lower proportions of specialty (1.9%-2.4%) and general medical (3.7%) visits compared with higher proportions of human services (18.9%) and complementary and alternative medicine (7.6%) visits. Only 26.5% of the services provided to the 8.0% of presumably low-need patients were delivered in the mental health specialty or general medical sectors.

Conclusions  Most services provided for emotional or substance use problems in the United States go to people with a 12-month diagnosis or other indicators of need. Patients who lack these indicators of need receive care largely outside the formal health care system.

Author Affiliations: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Druss); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Dr Wang); Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Ms Sampson and Dr Kessler); Department of Psychiatry, Columbia University, New York, New York (Drs Olfson and Pincus); and Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles (Dr Wells).