Skip to main content Accessibility help
×
Home

Treatment gap in common mental disorders: the Singapore perspective

  • S. A. Chong (a1), E. Abdin (a1), C. Sherbourne (a2), J. Vaingankar (a1), D. Heng (a3), M. Yap (a4) and M. Subramaniam (a1)...

Abstract

Aims.

The problem of wide treatment gaps in mental disorders is endemic world wide. The study aims to establish the treatment gap of common mental disorders in Singapore.

Methods.

A national sample of 6616 persons aged 18 years and above was surveyed with the World Mental Health Composite International Diagnostic Interview in which for each diagnostic module, respondents were asked a series of questions regarding treatment contact.

Results.

Treatment gap varied considerably between disorders; alcohol abuse had the largest treatment gap (96.2%), followed by obsessive compulsive disorder (89.8%) and alcohol dependence (88.3%). The disorder for which people were most likely to seek help was major depressive disorder. Women with dysthmia were more likely than men to seek help but this help seeking behavior was reversed among those with alcohol abuse and dependence. Age of onset was significantly associated with treatment contact with those who had an earlier age of onset less likely to have treatment contact than those with late age of onset for all disorders except obsessive compulsive disorder.

Conclusions.

Our findings suggest that treatment gaps are wide even in an economically developed country like Singapore and other than sociodemographic factors, cultural influences might play an important role in help seeking behavior.

Copyright

Corresponding author

*Address for correspondence: S. A. Chong, Institute of Mental Health. (Email: Siow_Ann_Chong@imh.com.sg)

References

Hide All
Alonso, J, Codony, M, Kovess, V, Angermeyer, MC, Katz, SJ, Haro, JM, De Girolamo, G, de Graaf, R, Demyttenaere, K, Vilagut, G, Almansa, J, Lepine, JP, Brugha, TS (2007). Population level of unmet need for mental healthcare in Europe. British Journal of Psychiatry 190, 299306.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Text Revision. Washington, DC.
Angold, A, Messer, SC, Stangl, D, Farmer, EM, Costello, EJ, Burns, BJ (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health 88, 7580.
Bijl, RV, Ravelli, A (2000). Psychiatric morbidity, service use, and need for care in the general population: results of the Netherlands Mental Health Survey and Incidence Study. American Journal of Public Health 90, 602607.
Bijl, RV, de Graaf, R, Hiripi, E, Kessler, RC, Kohn, R, Offord, DR, Ustun, B, Vicente, B, Vollebergn, A, Walters, EE, Wittchen, HU (2003). The prevalence of treated and untreated mental disorders in five countries. Health Affair (Millwood) 22, 122133.
Borges, G, Wang, PS, Medina-Mora, ME, Lura, C, Chiu, WT (2007). Delay of first treatment of mental and substance use disorders in Mexico. American Journal of Public Health 97, 16381643.
Bruffaerts, R, Bonnewyn, A, Demyttenaere, K (2007). Delays in seeking treatment for mental disorders in the Belgian general population. Social Psychiatry and Psychiatric Epidemiology 42, 937944.
Chong, SA, Bird, L (2004). Spreading the word. In The Outreach Programme of the Early Psychosis Intervention Programme, Singapore. Mental Health Promotion. Case Studies from Countries (ed. Saxena, S and Garrison, PJ). Joint Publication of the World Federation for Mental Health and the World Health Organization, 7678.
Chong, SA, Verma, S, Vaingankar, JA, Chan, YH, Wong, LY, Heng, BH (2007). Perception of the public towards the mentally ill in developed Asian country. Social Psychiatry and Psychiatric Epidemiology 42, 734739.
Christiana, JM, Gilman, SE, Guardino, M, Kessler, RC, Mickelson, K, Morselli, PL, Olfson, M (2000). Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychological Medicine 30, 693703.
Crisp, AH, Gelder, MG, Rix, S, Meltzer, HI, Rowlands, OH (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry 177, 47.
Elandt-Johnson, RC, Johnson, NL (1980). Survival Models and Data Analysis, pp. 392411. John Wiley & Sons: New York.
Finkelstein, N (1994). Treatment issues for alcohol and drug dependent pregnant and parenting women. Health and Social Work 19, 715.
Forthofer, MS, Kessler, RC, Story, AL, Gotlib, IH (1996). The effects of psychiatric disorders on the probability and timing of first marriage. Journal of Health and Social Behavior 37, 121132.
Friedman, PD, McCullough, D, Chin, MH, Saitz, R (2000). Screening and intervention for alcohol problems: a national survey of primary care physicians and psychiatrists. Journal of General Internal Medicine 15, 8491.
Hasin, DS, Grant, BF, Dufour, MG, Endicott, J (1990). Alcohol problems increase while physician attention declines: 1967 to 1984. Archives of Internal Medicine 150, 397400.
Hasin, DS, Stinson, FS, Ogburn, E, Grant, BF (2007). Prevalence, correlates, disability and comorbidity of DSM-IV alcohol abuse and dependence in the United States. Archives of General Psychiatry 64, 830842.
Kaner, EF, Heather, N, McAvoy, BR, Lock, CA, Gilvarry, E (1999). Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol and Alcoholism 34, 559566.
Kessler, RC, Price, RH (1993). Primary prevention of secondary disorders: a proposal and agenda. American Journal of Community Psychology 21, 607633.
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.
Kessler, RC, Brown, RL, Broman, CL (1981). Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. Journal of Health and Social Behavior 22, 4964.
Kessler, RC, Foster, CL, Saunders, WB, Stang, PE (1995). Social consequences of psychiatric disorders, I: educational attainment. American Journal of Psychiatry 152, 10261032.
Kessler, RC, Berglund, PA, Foster, Cl, Saunders, WB, Stang, PE, Walters, EE (1997 a). Social consequences of psychiatric disorder, II: teenage parenthood. American Journal of Psychiatry 154, 14051411.
Kessler, RC, Frank, RG, Edlund, M, Katz, SJ, Lin, E, Leaf, P (1997 b). Differences in the use of psychiatric outpatient services between the United States and Ontario. The New England Journal of Medicine 336, 551557.
Kessler, RC, Walters, EE, Forthofer, MS (1998 a). The social consequences of psychiatric disorders, III: probability of marital stability. American Journal of Psychiatry 155, 10921096.
Kessler, RC, Olfson, M, Berglund, PA (1998 b). Patterns and predictors of treatment contact after first onset of psychiatric disorders. American Journal of Psychiatry 155, 6269.
Kessler, RC, Demler, O, Frank, RG, Olfonso, M, Pincus, HA, Walters, EE, Wang, P, Wells, KB, Zaslavsky, AM (2005). Prevalence and treatment of mental disorders, 1990 to 2003. The New England Journal of Medicine 352, 25152523.
Keyes, CLM, Ryff, CD (2003). Somatization and mental health: a comparative study of the idiom of distress hypothesis. Social Sciences and Medicine 57, 18331845.
Kleinman, A (1982). Neurasthenia and depression: a study of somatization and culture in China. Culture Medicine and Psychiatry 6, 117190.
Kleinman, A (1986). Social Origin of Disease and Distress: Depression, Neurasthenia, and Pain in Modern China. Yale University Press: New Haven, CT.
Kohn, R, Saxena, S, Levav, I, Saraceno, B (2004). The treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.
Lee, ET (1992). Statistical Methods for Survival Data Analysis, 2nd edn., pp. 482. John Wiley & Sons: New York.
Lex, BW (1991). Some gender differences in alcohol and polysubstance users. Health Psychology 10, 121132.
Olfson, M, Kessler, RC, Berglund, PA, Lin, E (1998). Psychiatric disorder onset and first treatment contact in the United States and Ontario. American Journal of Psychiatry 155, 14151422.
Parker, G, Gladstone, G, Chee, KT (2001 a). Depression in the planet's largest ethnic group: the Chinese. American Journal of Psychiatry 158, 857864.
Parker, G, Cheah, YC, Roy, K (2001 b). Do Chinese somatize depression? A cross-cultural study. Social Psychiatry and Psychiatric Epidemiology 36, 287293.
Post, RM, Weiss, SR (1998). Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role of serotonergic mechanisms in illness progression. Biological Psychiatry 44, 193206.
Saitz, R, Svikis, D, D'Onofrio, G, Kraemer, KL, Perl, H (2006). Challenges applying alcohol brief interventions in diverse practice settings: populations, outcomes, and costs. Alcoholism, Clinical and Experimental Research 30, 332338.
SAS Institute Inc (2011). SAS/STAT 9.2 User's Guide. Cary, NC.
Singapore Department of Statistics (2009). Population Trends 2009. Retrieved 18h May 2011 from http://www.singstat.gov.sg/pubn/popn/population2009.pdf.
Saxena, S, Sharan, P, Saraceno, B (2003). Budget and financing of mental health services: baseline information on 89 countries from WHO's project atlas. Journal of Mental Health Policy Economics 6, 135143.
Subramaniam, M, Vaingankar, J, Heng, D, Kwok, KW, Lim, YW, Yap, M, Chong, SA. (in Press) The Singapore Mental Health Study: an overview of the methodology. International Journal of Methods in Psychiatric Research.
Thornicroft, G (2007). Most people with mental illness are not treated. Lancet 370, 807808.
Verhulst, FC, Koot, JM (1992). Child Psychiatric Epidemiology: Concepts, Methods and Findings. Sage Publications: Beverly Hills, CA.
Wang, PS, Berglund, PA, Olfson, M, Kessler, RC (2004). Delays in initial treatment contact after first onset of a mental disorder. Health Services Research 39, 393415.
Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 603613.
Wang, PS, Angermeyer, M, Borges, G, Bruffaerts, R, Chiu, T, Girolamo, G, Fayyad, J, Fureje, O, Haro, JM, Huang, Y, Kessler, RC, Kovess, V, Levinson, D, Nakane, Y, Brown, MAO, Ormel, JH, Villa, JP, Gixiola, SA, Alonso, J, Lee, S, Heeringa, S, Pennelle, BE, Chatterji, S, Ustun, TB (2007). Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6, 177185.
World Health Organization (2005). Mental Health Atlas. WHO: Geneva, Switzerland.
Ying, YW, Lee, PA, Tsai, JL, Yeh, YY, Huang, JS (2000). The conception of depression in Chinese American students. Cultural Diversity and Ethnic Minority Psychology 6, 183195.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed