Barriers to early service use by adolescents and young adults with psychiatric problems
01 / 2003 - 01 / 2005
Database Zorg Onderzoek Nederland ZON
Which barriers exist for seeking professional help in adolescents and young adults age 16-30 with psychiatric problems? Barriers will be determined according to type of mental health problem, based on self-report, as well as reported by significant others. Potential barriers will be investigated according to the health services utilisation model, including need for care, enabling factors (e.g. distance to services), and predisposing factors (e.g. causal attributions, opinions). During young adulthood the highest prevalence of mental illness has been found. Bijl et al. (1997) showed that the prevalence of DSM-lll-R disorders in young adults (18-24 years) was 34%, as compared to 23.5% in the total population studied. Having psychiatric problems during this period may cause premature termination of education, and unemployment. Depressive disorders (DD), anxiety disorders (AD) and substance use disorders (SUD) show little spontaneous improvement: 40-55% of patients with these disorders did not improve after one year (Wells et al., 1992; Bijl et al., 1997), and show a high recurrence rate (Angst, 1992). Treatment of DD and AD by a General Practitioner (GP), however, can be very effective, with 80% of patients showing improvement in one year (Ormel et al., 1993), the result of treatment depending e.g. on recognition by the GP and the presence of comorbididity. For SUD also effective treatments exist (Brink 1999). Despite this high psychiatric morbidity, Bijl et al. (2000) found that adolescents (18-24 years) were significantly less likely to seek some form of care as compared to older subjects (35-44 years; OR:1.66). Patients with DD used more care than subjects with SUD. In a study with adolescents, only 23% of those with psychiatric problems were referred to mental health services (referral to GP was not studied; Ferdinand et al., 1995). The following factors were associated with referral to mental health services in young adults: (1) impairment, (2) family stress, and (3) parental perception of the child's mental health service need (Ferdinand et al. 1995; Verhulst et al. 1997; Wu et al., 2001). In adults, other factors have been associated with utilisation of services, including (1) comorbidity and disability (Bijl et al., 2000), (2) socioeconomic factors: living alone, single parenthood, unemployment, education, and being publicly insured (Verhaak, 1995; Bijl et al., 2000), (3) attributions: a somatic attribution towards psychological problems was associated with using relatively less mental health services (Faller 1998), and (4) "tendency to consult" (van der Meer 1998). Little is known about these factors specifically in young adults, as well as other possible factors, including negative opinions about services, and stigma. Goldberg and Huxley (1992) described a model that consists of 5 levels, with each level representing a circumscribed population (e.g. general population , GP population, mental health population). To move from one level to the next, the subject has to pass through a filter. The factors that constitute these filters, also called barriers, have been described in a model supplementing the one of Goldberg and Huxley. This model is called the "health services utilisation model" (van der Meer 1998). The model describes the use of health services as a function of medical need and enabling and predisposing factors. This model will be tested in the present study. Aim of this study is to find barriers to early service use by adolescents and young adults (16-30 years) in the general population who have emotional/behavioral problems. A random selection of 3500 subjects will be assessed for the presence of psychiatric problems, level of functioning, help seeking behavior and barriers to service use. Help seeking behavior is defined as seeking help for psychiatric problems in the past twelve months at the level of primary care, ambulatory mental health care, residential care or informal care. Based on the health services utilisation model, subjects with psychiatric problems who seek help and who do not seek help, will be compared on the following characteristics: (1) subjective need for care, (2) enabling factors, e.g. distance to services, temporal availability of services, and (3) predisposing factors, e.g. attitudes towards health and health care, attributions towards psychological problems, and self-reported barriers. The importance of a significant other on the help seeking process will also be assessed. In addition, referral by a general practitioner to the mental health system will be studied in relation to the barriers mentioned above. The effects of these barriers on the help seeking process will be analyzed according to type of psychopathology. The results of this study will be implemented in ongoing youth mental health prevention programs of the Municipal Health Center Rotterdam.