Perceived Need for Care and Health Care Utilization Among Depressed and Anxious Patients With and Without Suicidal Ideation
Abstract
Background: Information is scarce concerning the perceived needs and the amount of health-care utilization of persons with suicidal ideation (SI) compared to those without SI. Aims: To describe the needs and health care use of persons with and without SI and to investigate whether these differences are associated with the severity of the axis-I symptomatology. Method: Data were obtained from 1,699 respondents with a depressive and/or anxiety disorder who participated in the Netherlands Study of Depression and Anxiety. Persons with and without SI were distinguished. Outcome variables were perceived needs and health-care utilization. We used multivariate regression in two models: (1) adjusted only for sociodemographic variables and (2) adjusted additionally for severity of axis-I symptomatology. Results: Persons with SI had higher odds for both unmet and met needs in almost all domains and made more intensive use of mental-health care. Differences in needs and health-care utilization of persons with and without SI were strongly associated with severity of axis I symptomatology. Conclusions: Our results validate previous findings about perceived needs and health-care use of persons with SI. The results also suggest that suicidal persons are more seriously ill, and that they need more professional care, dedication, and specialized expertise than anxious and depressed persons without SI, especially in the domains of information and referral.
References
2001). Diagnostic and statistical manual of mental disorders DSM-IV-TR (4th ed., text revision). Washington, DC: Author.
. (2003). Practice guideline for the assessment and treatment of patients with suicidal behavior. Washington, DC: Author.
. (1999). Suicide risk in patients with major depressive disorder. Journal of Clinical Psychiatry, 60(Suppl. 2), 57–62.
(1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.
(1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.
(2009). A global perspective on the magnitude of suicide mortality. In , Oxford textbook of suicidology and suicide prevention: A global perspective (pp. 91–98). Oxford: Oxford University Press.
(2006). Mental health care for adults with suicide ideation. General Hospital Psychiatry, 28, 271–277.
(2012). Treatment of suicidal people around the world. British Journal of Psychiatry, 199, 64–70.
(2007). Treatment adequacy for anxiety and depressive disorders in six European countries. British Journal of Psychiatry, 190, 172–173.
(2009). Countertransference in the treatment of suicidal patients. In , Oxford textbook of suicidology and suicide prevention: A global perspective (pp. 389–393). Oxford, UK: Oxford University Press.
(2002). Manual Trimbos/iMTA questionnaire for costs associated with psychiatric illness (in Dutch). Rotterdam, The Netherlands: Institute for Medical Technology Assessment.
(2006). Problems in psychotherapy with suicidal patients. American Journal of Psychiatry, 163, 67–72.
(2006). Managing suicidal risk. A collaborative approach. New York, NY: Guilford.
(2000). Assessing perceived need for mental health care in a community survey: Development of the Perceived Need for Care Questionnaire (PNCQ). Social Psychiatry and Psychiatric Epidemiology, 35, 427–435.
(2009). Help seeking and perceived need for mental health care among individuals in Canada with suicidal behaviors. Psychiatric Services, 60, 943–949.
(2008). The Netherlands Study of Depression and Anxiety (NESDA): Rationale, objectives, and methods. International Journal of Methods in Psychiatric Research, 17, 121–140.
(2001a). Self-reported needs for care among persons who have suicidal ideation or who have attempted suicide. Psychiatric Services, 52, 381–383.
(2001b). Suicidal ideation and suicide attempts as predictors of mental health service use. Medical Journal of Australia, 175, 542–545.
(2011). Perceived need for mental health care and barriers to care in the Netherlands and Australia. 'Social Psychiatry and Psychiatric Epidemiology, 46, 1033–1044.
(2009). Primary care patients with anxiety and depression: Need for care from the patient’s perspective. Journal of Affective Disorders, 119, 163–171.
(1996). The Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477–486.
(2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62, 1249–1257.
(2005). The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: A Canadian population-based survey. Canadian Journal of Psychiatry, 50, 87–94.
(2004). Does meeting needs improve quality of life? Psychotherapy and Psychosomatics, 73, 183–189.
(2009). Attitudes toward clinical services among people who self-harm: Systematic review. British Journal of Psychiatry, 194, 104–110.
(2011). Are attitudes toward mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders. Social Psychiatry and Psychiatric Epidemiology, 45, 153–163.
(2009). Incidence and course of suicidal ideation and suicide attempts in the general population. Canadian Journal of Psychiatry, 54, 824–833.
(2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet, 380, 841–850.
(2006). Needs of people with severe mental illness. Acta Psychiatrica Scandinavia, 429(Suppl.), 115–119.
(2005). In , Prevention and treatment of suicidal behavior. From science to practice (pp. 71–88). Oxford: Oxford University Press.
(1994). Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): A critical review. Journal of Psychiatric Research, 28, 57–84.
(1998). Composite International Diagnostic Interview (CIDI) (Version 2.1.). Geneva: Author.
. (