Margreet ten Have

Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands

OBJECTIVE Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems. METHODS Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier. RESULTS The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands. CONCLUSIONS Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands.

Bipolar disorder in the general population in The Netherlands (prevalence, consequences and care utilisation): results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

BACKGROUND Little is known about the prevalence of bipolar disorder in the general population, what proportion is receiving care and what factors motivate people to seek help. METHOD Data were derived from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in the general population in The Netherlands. DSM-III-R diagnoses were based on the Composite International Diagnostic Interview (CIDI). RESULTS Lifetime prevalence of bipolar disorder was 1.9%. Compared to other mental disorders, people with bipolar disorder were more often incapacitated were more likely to have attempted suicide and reported a poorer quality of life 82.8% had experienced an additional mental disorder in their lifetime; 25.5% had never sought help for their emotional problems, not even primary, informal or alternative care. LIMITATIONS Three limitations of the study are: (1) the CIDI prevalence estimates for bipolar disorder may be inflated; (2) personality disorders were not recorded in the NEMESIS dataset; (3) in NEMESIS certain groups have not been reached. CONCLUSION Three-quarters of the bipolar respondents do not benefit sufficiently from the treatment methods now available. In view of the serious consequences of this condition, greater efforts are needed to reach people with bipolar disorder, to get them into treatment.

Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2

OBJECTIVE To present prevalences of lifetime and 12-month DSM-IV mood, anxiety, substance use and impulse-control disorders from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), and to compare the 12-month prevalence of mood, anxiety and substance use disorders with estimates from the first study (NEMESIS-1). METHOD Between November 2007 and July 2009, a nationally representative face-to-face survey was conducted using the Composite International Diagnostic Interview 3.0 among 6,646 subjects aged 18-64. Trends in 12-month prevalence of mental disorders were examined with these data and NEMESIS-1 data from 1996 (n = 7,076). RESULTS Lifetime prevalence estimates in NEMESIS-2 were 20.2% for mood, 19.6% for anxiety, 19.1% for substance use disorder and 9.2% for impulse-control disorder. For 12-month disorders, these figures were 6.1, 10.1, 5.6 and 2.1%, respectively. Between 1996 and 2007-2009, the 12-month prevalence of anxiety and substance use disorder did not change. The prevalence of mood disorder decreased slightly but lost significance after controlling for differences in sociodemographic variables between the two studies. CONCLUSION This study shows that in the Netherlands mental disorders are prevalent. In about a decade, no clear change in mental health status was found.

Childhood adversities and risk for suicidal ideation and attempts : a longitudinal population-based study

BACKGROUND Developmental adversities may be risk factors for adult suicidal behavior, but this relationship has rarely been studied prospectively. The present study examined the association between childhood adversities and new onset suicidal ideation and attempts in an adult population-based sample. METHOD The study used a large community mental health survey (the Netherlands Mental Health Survey and Incidence Study; n=7076, age range 18-64 years). Logistic regression analyses were used to evaluate the relationship between childhood adversities and new onset of suicidal ideation and attempts over 3 years of longitudinal follow-up. RESULTS During the study period 85 new cases of suicidal ideation and 39 new onset suicide attempts were observed. The incidence rate for new suicide ideation was 0.67% per year and the incidence rate for new suicide attempts was 0.28% per year. Childhood neglect, psychological abuse and physical abuse were strongly associated with new onset suicidal ideation and suicide attempts. Odds ratios (ORs) ranged from 2.80 to 4.66 for new onset suicidal ideation and from 3.60 to 5.43 for new onset suicide attempts. The total number of adversities reported had a strong graded relationship to new onset suicidal ideation and attempts. These associations remained significant after controlling for the effects of mental disorders. CONCLUSIONS Childhood abuse and multiple adversities are strongly associated with future suicidal behavior and the mental disorders assessed in the present study do not fully account for this effect. A comprehensive understanding of suicidal behavior must take childhood adversities into account.

Incidence and Course of Suicidal Ideation and Suicide Attempts in the General Population

Objective: Suicidal ideation and suicide attempts are important indicators of extreme emotional distress. However, little is known about predictors of onset and course of suicidality in the general population. Our study tried to fill this gap by analyzing data from a prospectively followed community sample. Method: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a 3-wave cohort study in a representative sample (n = 4848) of the Dutch adult general population. Results: The 3-year incidence of suicidal ideation and suicide attempts was 2.7% and 0.9%, respectively. Predictors of first-onset suicidal ideation and suicide attempts were sociodemographic variables (especially the negative change in situation variables), life events, personal vulnerability indicators, and emotional (mood and anxiety) disorders. Comparison of the corresponding odds ratios and confidence intervals revealed that predictors for first-onset suicidal ideation and suicide attempts did not differ significantly. One of the strongest predictors of incident suicide attempts was previous suicidal ideation. Regarding the course of suicidal ideation, it was found that 31.3% still endorsed these thoughts and 7.4% reported having made a suicide attempt 2 years later. Conclusions: Similar predictors were found for first-onset suicidal ideation and suicide attempts. This suggests that suicidal behaviours may be ordered on a continuum and have shared risk factors. While suicidal thoughts may be necessary for, they are not sufficient predictors of, suicidal acts. The course of suicidality in the general population can be characterized by a minority of people having suicidal experiences that develop over time with progressively increasing severity.

Screening for mood and anxiety disorders with the five-item, the three-item, and the two-item mental health inventory

The Mental Health Inventory (MHI)-5 is an attractive, brief screening questionnaire for depression and anxiety disorders. It has been suggested that the three questions on depression (MHI-d) may be as good as the full MHI-5 in assessing depressive disorders. We examined the validity of the MHI-d and the MHI-a (the remaining two items on anxiety) in a large population-based sample of 7076 adults in the Netherlands. We also examined the validity of the MHI in assessing specific anxiety disorders. The presence of depressive and anxiety disorders in the past month was assessed with the Composite International Diagnostic Interview (CIDI), computerized version 1.1. ROC analyses indicated no significant difference between the MHI-5 (area under the curve of 0.93) and the MHI-d (area under the curve of 0.91) in detecting major depression and dysthymia. There was no difference either between the MHI-5 (area under the curve of 0.73) and the MHI-a (area under the curve 0.73) in detecting anxiety disorders. Both the MHI-5 and the MHI-a also seem to be adequate as a screener for some anxiety disorders (generalized anxiety disorder; panic disorder; obsessive-compulsive disorder), but not others, especially phobias (agoraphobia; social phobia; simple phobia).

The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods

The psychiatric epidemiological population study NEMESIS‐2 (Netherlands Mental Health Survey and Incidence Study‐2) replicates and expands the first Netherlands Mental Health Survey and Incidence Study (NEMESIS‐1) conducted from 1996 to 1999. The main objectives of the new study are to provide up‐to‐date figures on the prevalence, incidence, course and consequences of mental disorders, and to study trends in mental disorders and service use, with the use of a new sample. New topics not included in NEMESIS‐1 were added, e.g. impulse‐control disorders, and genetic correlates of mental disorders through gathering DNA from saliva samples. This paper gives an overview of the design of NEMESIS‐2, especially of its recently completed first wave. NEMESIS‐2 is a prospective study among Dutch‐speaking subjects aged 18–64 years from the general Dutch population. Its baseline wave included 6646 subjects. Three waves are planned with three year‐intervals between the waves. A multistage, stratified random sampling procedure was applied. The baseline wave of NEMESIS‐2 was performed between November 2007 and July 2009. Face‐to‐face interviews were administered with the Composite International Diagnostic Interview (CIDI) 3.0. The response rate was 65.1%, and 76.4% of the respondents donated saliva. The sample was reasonably nationally representative, but younger subjects were somewhat underrepresented. In conclusion, we were able to build a comprehensive dataset of good quality, permitting several topics to be studied in the future. Copyright

Mental health in immigrant children in the Netherlands

BackgroundBackground In the past decades, the ethnic diversity of the population in the Netherlands has rapidly grown. At present, approximately 10% of all people in the Netherlands belong to immigrant families that originate from a very large variety of non-Western nations. Although it is often assumed that migration has a stress-inducing effect, leading to heightened levels of mental health problems in both immigrant children and their parents, research into this group of children is very scarce in Europe. In this paper, we want to report on the mental health of immigrant children originating from non-Western countries enrolled in a large cohort study in the Netherlands.MethodA large sample of 11-year-old children in the Netherlands (n=2230) participated in the TRacking Adolescents’ Individual Lives Survey (TRAILS). Approximately 10% of these children (n=230) belong to immigrant families originating from non-Western countries. Mental health problems were assessed using self-report measures (Youth Self-Report), using parent-report measures (Child Behaviour Check List) and using teacher report (Teacher Checklist for Psychopathology). In this paper, we report on the mental health problems of these children from all three perspectives (child, parent, teacher). In analysing the impact of immigrant status, the effect of gender and of socio-economic inequality was taken into account.ResultsAccording to self-report measures, mean level of mental health problems in immigrant children is comparable to that in non-immigrant children. Immigrant parents report higher problem rates for their daughters, in particular for internalising problem behaviours, social problems and attention problems, but not for their sons. In contrast, teachers perceive higher levels of externalising problem behaviour, but lower levels of anxious/depressed problems, social problems and thought problems in immigrant children. This last effect is most strongly found with respect to boys: teachers perceive less withdrawn/depressed problems, social problems, thought problems and attention problems in immigrant boys.ConclusionsChildren from immigrant families do not appear to experience more problems than their non-immigrant peers. However, parents from immigrant families do report more problems in their daughters than non-immigrant parents, in contrast to teachers who perceive lower levels of internalising, social and thought problems in particular in boys, and higher levels of externalising problems in both immigrant boys and girls. In describing problem behaviour in immigrant children, the effect of diverging social contexts for and multiple perspectives on immigrant youth has to be taken into account.

Child Abuse and Health-Related Quality of Life in Adulthood

Past research has indicated that child abuse is related to mental and physical health conditions and that mental and physical health conditions are related to decreased health-related quality of life (HRQOL). However, little is known about the independent relationship between child abuse and HRQOL. For the current analysis, data were from the nationally representative Netherlands Mental Health Survey and Incidence Study. Multiple linear regression analyses tested the relationships between child abuse and current HRQOL (SF-36) after adjusting for the effects of sociodemographic variables and numerous psychiatric disorders and physical health conditions. Neglect, psychological abuse, physical abuse, severe sexual abuse, and number of types of child abuse experienced were associated with reduced mental HRQOL. Psychological abuse, physical abuse, and number of types of child abuse experienced were associated with reduced physical HRQOL. Child abuse is an important determinant of HRQOL. The ability to successfully reduce the occurrence of child abuse or provide early intervention after child abuse occurs may help to improve HRQOL in the general population.

The Disease Burden of Childhood Adversities in Adults: A Population-Based Study.

OBJECTIVES There is much evidence showing that childhood adversities have considerable effects on the mental and physical health of adults. It could be assumed therefore, that the disease burden of childhood adversities is high. It has not yet been examined, however, whether this is true. METHOD We used data of a large representative sample (N=7,076) of the general population in the Netherlands. We calculated the disability weight (DW) for each respondent. The DW is a weight factor that reflects the severity of a disease or condition on a scale from 0 (perfect health) to 1 (equivalent to death). We used an algorithm based on the SF-6D to estimate DW. Because the DW indicates the proportion of a healthy life year that is reduced by the specific health state of the individual, it also possible to calculate the total number of years lost due to disability (YLD) in the population. We calculated the years lived with disability (YLD) for 9 different childhood adversities (in the areas of parental psychopathology; abuse and neglect; major life events), as well as for major categories of mental disorders and general medical disorders. RESULTS All 9 adversities resulted in a significantly increased DW, except death of a parent before the age of 16. Adversities in the category of abuse and neglect are associated with the highest DWs (0.057), followed by parental psychopathology (0.031) and life events during childhood (0.012). All adversities (46.4% of the population reports one or more adversity) are associated with 20.7 YLD/1,000, which is more than all mental disorders together (12.9 YLD/1,000). The category of abuse/neglect has the highest YLD/1,000 (15.8), which is also higher than all mental disorders together. Adjustment for the presence of mental and general medical disorders resulted in comparable outcomes. CONCLUSIONS Childhood adversities are more important from a public health point of view than all common mental disorders together, and should be a priority for public health interventions.