In the past decade, the use of mental health treatment in the United States
has dramatically increased. Still, many Americans are not receiving minimally
adequate care for mental illness.
That's one of numerous findings from the National Comorbidity Survey
Replication (NCS-R), published in the June Archives of General
Psychiatry in four papers. The NCS-R is a follow-up of the National
Comorbidity Survey, whose results provided an overview of Americans' mental
health a decade ago.
The lead author of the NCS-R was Ronald Kessler, Ph.D., a professor of
health care policy at Harvard Medical School. Other researchers, including
psychiatrists, were involved as well.
Although results from the survey are extensive, five major findings stand
Pincus said that he was surprised at "how few people had minimally
adequate care— even those seen by psychiatrists, and even those with
pretty significant conditions."
Philip Wang, M.D., Ph.D., told Psychiatric News that he was
surprised by this finding as well. Wang is an assistant professor of
psychiatry at Harvard Medical School and one of the survey authors.
The irony, Wang said, is "that despite the fairly dramatic increase
in the use of mental health treatments that has occurred over the past decade,
the adequacy of treatments received by individuals really hasn't
Nonetheless, while increased use of mental health treatments does not
appear to have benefited the public as a whole, undoubtedly individual
patients have improved because of them, Kenneth Wells, M.D., believes. Wells
is a professor in residence in psychiatry at the University of California at
Los Angeles and one of the survey authors.
"The NCS-R study offers some new exploratory data that, along with
other research studies, stand to have an impact on the mental health field and
need to be further validated in order to understand the greater implications
of the findings," Darrel Regier, M.D., said in an APA press release
issued in conjunction with publication of the NCS-R results. "It is
important to note that new findings typically need replication and
Regier is director of the APA Division of Research and the American
Psychiatric Institute for Research and Education.
"The findings reported here are the first of what promises to be a
bountiful harvest," Thomas Insel, M.D., and Wayne Fenton, M.D., wrote in
an editorial accompanying publication of the results. "The NCS-R is one
element in a coordinated program of new psychiatric epidemiological studies
that will be completed over the next several years." Insel is director
of the National Institute of Mental Health (NIMH); Fenton is director of the
Division of Adult Translational Research and associate director for clinical
affairs at NIMH.
The NCS-R was based on interviews of a nationally representative sample of
Americans conducted from 2001 to 2003. More than 9,000 subjects aged 18 and
older were interviewed using the World Mental Health Survey version of the
Composite International Diagnostic Interview, which generates diagnoses of
mental disorders in accord with DSM-IV.
The study was funded by the NIMH, National Institute on Drug Abuse,
Substance Abuse and Mental Health Services Administration, Robert Wood Johnson
Foundation, and John W. Alden Trust.
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