Unmet Need For Mental Health Treatment Research Articles

Annual use and perceived need for mental health and substance treatment among people in remission from substance use disorders in the United States

BackgroundReceiving specialty substance treatment or general mental health treatment during remission from substance use disorders (SUD) may reduce odds of SUD recurrence, but little is known about prevalence of treatment or perceptions of treatment need among remitted people in the United States. SampleParticipants in the National Survey on Drug Use and Health, years 2018–2020, were considered remitted if they ever had an SUD (i.e., self-reported history of “problems with alcohol or drugs”, or lifetime history of treatment for SUD) but did not meet DSM-IV criteria for substance abuse or dependence during the prior year (n = 9,295). AnalysesAnnual prevalence was estimated for any SUD treatment (e.g., mutual-help groups), any mental health (MH) treatment (e.g., private therapy), self-reported perceived need for SUD treatment, and self-reported unmet need for MH treatment. Generalized linear models examined effects of socio-demographics, mental illness, past-year substance use, and self-identified recovery status on outcomes. FindingsMH treatment was more common than SUD treatment (27.2% [25.6%, 28.8%] v. 7.8% [7.0%, 8.6%], respectively). Unmet need for mental health treatment was reported by 9.8% [8.8%, 10.9%], but only 0.9% [0.6%, 1.2%] perceived need for substance treatment. Age, sex, marital status, education, health insurance, mental illness, and prior year alcohol use were among the factors associated with variation in outcomes. ConclusionMost people who maintained clinical remission from substance use disorders in the U.S. during the prior year did so without treatment. Remitted people report substantial unmet need for mental health treatment, but not specialized substance use treatment.

Alcohol use and cannabis use trajectories and sexual/gender minority disparities in young adulthood.

Sexual and gender minority (SGM) young people may use alcohol or cannabis (A/C) at higher rates that non-SGM peers, but little is known about whether SGM young adults experience poorer health, psychosocial, and other outcomes at similar levels of A/C use. We used longitudinal survey data from a community cohort recruited from California middle schools in 2008 (average age 11.5) and followed across 12 waves through 2020. Participants reported on past-month A/C use at each wave. Individuals also reported SGM status as well as outcomes in multiple domains in Wave 12. Sequelae of change models tested differences in intercept and slope for A/C use trajectories from Waves 1-12 across SGM groups, and simultaneously examined differences in outcomes by SGM status adjusting separately for A/C trajectories. SGM (n = 445) and non-SGM (n = 2,089) groups did not differ on baseline probability of A/C use. SGM individuals showed steeper increases in probability of cannabis but not alcohol use over time. Adjusting for trajectories of A/C use, SGM individuals had significant disparities relative to non-SGM peers with respect to: Employment and economic stability, criminal justice involvement, social functioning, subjective physical health, behavioral health, and perceived unmet mental health treatment need. At the same levels of A/C use from middle school through young adulthood, SGM individuals show disparities in multiple domains compared to non-SGM peers. Targeted efforts to reduce substance use in conjunction with other structural disadvantages experienced by SGM youths are needed to address the emergence of disparities in young adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Medicaid Waivers for Youth with Severe Emotional Disturbance: Associations with Public Health Coverage, Unmet Mental Health Needs & Adequacy of Health Coverage.

Home and Community-Based Services (HCBS) Medicaid waivers for Serious Emotional Disturbance (SED) extend Medicaid eligibility to youth who otherwise would be financially ineligible and finance a broad array of highly specialized mental health services specific to the needs of youth with SED. This study examines whether these policies are associated with greater public health insurance coverage among youth with severe mental health diagnoses. It also assesses, among youth with severe mental health diagnoses who have public health coverage, whether waiver policies are associated with reduced reports of unmet mental health treatment need and increased reports of adequate mental health coverage. Analysis uses CMS reported data on state HCBS Medicaid waivers in conjunction with data from the National Survey of Children's Health for the years 2016 through 2018. Multi-level, fixed-effects logistic regression models demonstrate that living in a state with an HCBS Medicaid waiver is associated with significantly increased odds of having public insurance among children with concurrent private health coverage (OR 1.89), reduced odds of unmet mental health needs among youth with public coverage (OR 0.45), but not significantly associated with reported adequacy of mental health insurance coverage.

Racial/ethnic differences in mental health treatment among a national sample of pregnant women with mental health and/or substance use disorders in the United States

ObjectiveTo examine racial/ethnic differences in the receipt of mental health treatment among pregnant women with mental health (i.e., depression and serious psychological distress) and/or substance use disorders. MethodSecondary analysis of data from the National Survey on Drug Use and Health was conducted. The sample consisted of 1232 pregnant women with mental health/substance use disorders. ResultsBlack/African American (Adjusted Odds Ratio [AOR]: 0.36, 95% Confidence Interval [CI]: 0.17–0.75), other non-Hispanic (AOR: 0.24, 95% CI: 0.11–0.52), and Hispanic (AOR: 0.42, 95% CI: 0.22–0.81) pregnant women had significantly lower odds of mental health treatment receipt compared to Whites, even when controlling for age, education, marital status, number of children, employment status, income, health insurance, county urbanicity, self-rated health status, type of mental health condition, and time. There were no racial/ethnic differences by mental health and/or substance use disorders. Among pregnant women who perceived unmet mental health treatment need (N = 299), a greater proportion of White compared to Non-White pregnant women perceived cost as an obstacle to access treatment (62.1% vs. 35.6%, p = .001); however, the two groups did not differ in other perceived barriers to mental health treatment (i.e., opposition to treatment, stigma, time/transportation limitation, and not knowing where to go). ConclusionsStrategies are needed to increase access to mental health treatment among racial/ethnic minority women who are pregnant and have mental health/substance use disorders. Further studies are required to understand racial/ethnic differences in the perceived barriers to mental health treatment.

Unmet Mental Health Treatment Need and Attitudes Toward Online Mental Health Services Among Community College Students.

A survey assessed use of and attitudes toward online mental health services among community college students to inform how such services may contribute to reducing unmet treatment need. A total of 6,034 students completed a Web-based survey on mental health and use of and attitudes toward mental health services. Logistic regression assessed the relationship between prior mental health treatment and attitudes among students with current serious psychological distress. Among students with psychological distress (N=1,557), 28% reported prior in-person service use and 3% reported online mental health services use; most (60%) reported willingness to use online services. Students with no prior in-person treatment were less likely than those with history of in-person treatment to endorse preferences for in-person services (adjusted odds ratio=.54). Students reported being open to using online mental health services, but utilization was low. Targeted outreach efforts may be required if these services are to reduce unmet treatment need.

Perceived Unmet Mental Health Treatment Need Among Adults with Criminal Justice System Involvement.

Research shows criminal justice system involved individuals are more likely to have behavioral health needs. This study analyzes nationally representative data on non-incarcerated individuals with mental disorders. It examines whether having past year criminal justice system involvement was associated with perceiving an unmet need for mental health treatment and the reasons for that unmet need. Results show criminal justice system involved individuals were more likely to report perceived unmet need for mental health treatment (OR = 1.20, p <.001). Among those not receiving mental health treatment, criminal justice system involvement yielded a higher relative risk of identifying affordability as the primary reason for having unmet mental health treatment need (RRR = 1.92, p <.001). Among those receiving mental health treatment, having criminal justice system involvement yielded a higher relative risk of identifying stigma as the primary reason for having unmet need (RRR = 1.99, p <.001).

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.

Hope thinking and past trauma mediate the relationships of body mass index with perceived mental health treatment need and mental health treatment use.

Greater body mass is associated with a greater risk of mental health conditions and more frequent mental health treatment use. However, factors that might influence perceived mental health treatment need and mental health treatment use among those of greater weight, including hope thinking, trauma history and perceived mental health treatment stigma, are not well understood. The objective of this study was to determine if hope thinking, trauma history and/or perceived mental health treatment stigma mediate the relationships of body mass index [BMI] with perceived mental health treatment need and mental health treatment use. Primary care clinic patients in the Midwest United States (N = 196; BMI range = 18.5 to 47.0, mean = 29.26 ± 6.61, median = 27.90) were recruited to complete a battery of self-report measures that assessed perceived mental health treatment need, mental health treatment use, hope thinking (Trait Hope Scale), trauma history (a single-item traumatic event history screen from the posttraumatic stress disorder module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and perceived mental health treatment stigma (Stigma Scale for Receiving Psychological Help). Reduced hope thinking and a greater incidence of past trauma accounted for greater perceived mental health treatment need and greater mental health treatment use among those of greater BMI. BMI was not related to perceived unmet mental health treatment need. Increased perceived mental health treatment need and mental health treatment use among those of greater BMI may be explained by lower hope thinking and a greater incidence of trauma in this population. Heavier patients may benefit from interventions designed to augment hope and address traumatic histories.

Do the Guidelines for Adolescent Preventive Services (GAPS) Facilitate Mental Health Diagnosis?

To determine if the Guidelines for Adolescent Preventive Services (GAPS) increases detection or shortens time to diagnosis of mental health (MH) disorders, particularly adolescent depression. Starting in May 1999, GAPS questionnaires were routinely administered at adolescent annual visits at 1 primary care clinic in a rural health network. Using an administrative database, we enumerated all MH diagnostic codes for outpatient visits of adolescents aged 13 to 15 years. Population based rates were derived using school enrollment data. Using time series, the rates of MH diagnoses were compared pre- and post-GAPS. Using survival analysis, the time to any MH diagnosis subsequent to index annual visits was also compared pre- and post-GAPS. Because the GAPS questionnaire includes questions for depressed mood, anhedonia, and suicidality, ICD-9-CM codes for depression and mood disorder were also analyzed separately. Time series analysis included 8112 adolescents. The rate of MH diagnosis did not change pre- and post-GAPS (P = .13). Time to any MH diagnosis was similar pre-GAPS (9.0 months) and post-GAPS (7.0 months, log rank P = .30). Time to any first diagnosis of depression or mood disorder was similar post-GAPS (12.2 months) versus pre-GAPS (11.0 months, log rank P = .34). Use of the GAPS was not associated with change in the rate of or time to MH diagnosis. Our results challenge the prevalent expectation that requiring mental health screening will reduce unmet need for MH treatment. Validated MH screening tools, primary care provider training, and access to MH services may also be needed but further study is required.

Service Use and Barriers to Mental Health Care Among Adults With Major Depression and Comorbid Substance Dependence

The study explored mental health service use patterns and barriers to care among individuals with comorbid mental and substance use disorders. Using data from the National Survey on Drug Use and Health (2005-2010) for 18,972 adults with past-year major depressive episodes, the study compared mental health service use and perceived barriers to care among participants with and without co-occurring alcohol dependence, nonalcohol drug dependence, and both alcohol and drug dependence. Compared with participants without comorbid substance dependence, participants with alcohol dependence or both alcohol and nonalcohol drug dependence used more mental health services of all types, and participants with only comorbid alcohol dependence used more medication treatments. Participants with comorbid substance dependence were significantly more likely than those without comorbid substance dependence to report unmet mental health treatment need. However, barriers to mental health care were remarkably similar across groups, with financial barriers being the most common in all groups. Participants with major depression comorbid with substance dependence used more mental health services but also perceived more unmet need for such care than individuals without such comorbidity. However, barriers to mental health care were similar across groups with and without comorbidity. Policies aimed at expanding insurance coverage and mental health parity would likely benefit individuals with major depression and substance dependence comorbidity even more than those without such comorbidity.

Unmet need for treatment of substance use disorders and serious psychological distress among veterans: a nationwide analysis using the NSDUH.

Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prevalence of unmet MH needs among veterans aged 21 to 34 in the general population. The prevalence of untreated SUD among veterans (16%) was twice as high as untreated SPD (8%), a nonspecific diagnosis of serious MH concerns. Surprisingly, similar rates of untreated SUD and SPD were found among a nonveteran comparison sample matched on gender and age. These findings suggest that reducing unmet need for MH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment. The need for further analyses of reasons for not obtaining treatment is discussed.