Mental Health Services Use Predicted by Number of Mental Health Problems and Gender in a Total Population Study

Maj-Britt Posserud,Astri J Lundervold

doi:10.1155/2013/247283

Maj-Britt Posserud, Astri J Lundervold

Open Access

https://doi.org/10.1155/2013/247283

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Abstract

We examined the relationship between service use and the number of problem areas as reported by parents and teachers on questionnaires among children aged 7–9 years old in the Bergen Child Study, a total population study including more than 9000 children. A problem area was counted as present if the child scored above the 95th percentile on parent and/or teacher questionnaire. A total number of 13 problem areas were included. Odd ratios (ORs) for contact with child and adolescent mental health services (CAMH), school psychology services (SPS), health visiting nurse/physician, and school support were calculated with gender as covariate. The number of symptom areas was highly predictive of service use, showing a dose-response relationship for all services. Children scoring on ≥4 problem areas had a more than hundredfold risk of being in contact with CAMH services compared to children without problems. The mean number of problem areas for children in CAMH and SPS was 6.1 and 4.4 respectively, strongly supporting the ESSENCE model predicting multisymptomatology in children in specialized services. Even after controlling for number of problem areas, boys were twice as likely as girls to be in contact with CAMH, replicating previous findings of female gender being a strong barrier to mental health services.

Highlights

Already in 1979, when elaborating on taxonomy and classification, in view of the coming DSM-III manual, Woods declared that “Substantially supplanting this nineteenth century definition of disease as structural lesion or abnormality is the notion of disease as construct rather than material that exists in the ostensive finger-pointing sense
We examined the relationship between service use and the number of problem areas as reported by parents and teachers on questionnaires among children aged 7–9 years old in the Bergen Child Study, a total population study including more than 9000 children
Children scoring on ≥4 problem areas had a more than hundredfold risk of being in contact with child and adolescent mental health services (CAMH) services compared to children without problems

Summary

Introduction

Already in 1979, when elaborating on taxonomy and classification, in view of the coming DSM-III manual, Woods declared that “Substantially supplanting this nineteenth century definition of disease as structural lesion or abnormality is the notion of disease as construct rather than material that exists in the ostensive finger-pointing sense. Diseases of all sorts are constructs that are found useful at different points in time for organizing subject matter” [1]. He might have been a bit too optimistic, as we still in the 21st century tend to overlook this fundamental dogma. Both in clinical and population studies, psychiatric comorbidity is generally prevalent [2,3,4,5] and underresearched, especially regarding treatment, as many trials exclude individuals with certain kinds of comorbidity [6, 7]. The very word comorbidity leads us to believe that the two “comorbid” disorders exist as separate, distinct entities. According to the diagnostic criteria, these disorders are mutually exclusive [9], recent research (ignoring the diagnostic criteria) points to tight links both genetically and clinically between the two disorders

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