Co-occurring psychiatric disorders appear to have an effect on time to first treatment seeking following MDD onset. Several comorbid psychiatric disorders, especially panic disorder, GAD, and dysthymic disorder, were significantly but modestly associated with shorter delays in treatment seeking. In keeping with earlier research, we found that the probability of lifetime treatment seeking for MDD is greater for females than males, whites than non-whites (28
), and married than never married individuals after adjusting for several potential demographic and clinical confounds (3
Seeking help for depression and other mental health problems is thought to progress through several stages including subjective experience of symptoms, assessment of their significance and potential consequences, evaluation of whether the symptoms require intervention, and weighing the benefits and costs of various treatment options (29
). Comorbid psychiatric disorders may act early in this process to increase, and sometimes to decrease, perceived need for treatment (30
). In one study, individuals with past year comorbid mood and anxiety disorders were more likely than their counterparts with mood disorders alone to perceive a need for mental health treatment (29
Panic disorder stood out as the comorbid disorder associated with the fastest time to first depression treatment contact. Panic disorder itself is associated with a comparatively short period of latency to first treatment seeking (3
). The abrupt, intense, unexpected, and frightening somatic nature of panic attacks may prompt depressed individuals with this comorbidity to seek general medical care and in the course of treatment co-occurring depressive symptoms may become a focus of care.
Dysthymic disorder also had a strong association on decreasing treatment delay. The persistence of distress, a characteristic of dysthymic disorder, may contribute to help seeking following MDD onset. In several contexts, decisions to use medical care for new symptoms are more likely if the new symptoms are experienced in association with prolonged rather than recent distress (32
PTSD was also associated with shorter delays in treatment seeking for depression. A similar association has been reported among Canadian military personnel (13
). PTSD symptom severity is itself a strong independent predictor of mental health treatment (33
). Because persons with PTSD are at markedly increased risk MDD (34
), treatment seeking for PTSD may increase opportunities for attention to comorbid depression.
Comorbid substance use disorders bore a complex relationship to treatment timing among depressed individuals. Comorbid alcohol abuse and dependence did not significantly shorten delays in depression treatment seeking. Alcohol use disorders are associated with long delays in treatment seeking (3
) and failure to perceive a need for treatment (35
). When they occur as comorbidities with depression, alcohol use disorders may do little to accelerate depression treatment seeking. By contrast, comorbid drug use disorders were linked to shorter delays in first depression treatment. In a previous study, drug use disorders were proportionately more likely than alcohol use disorders to be associated with a perceived need for mental health treatment (36
). In view of the high prevalence of comorbid alcohol use disorders among depressed individuals (37
), the substantial associated functional impairment (38
), guarded prognosis (39
), and evidence that antidepressants are equally effective in depressed patients with or without alcohol use disorder (40
), a strong rationale exists for focusing efforts on promoting timely depression treatment in this population.
The results should be interpreted within the context of several limitations. First, the reliability of lifetime MDD is modest. Bromet and associates reported that the 18-month test-retest reliabilities for definite and probable lifetime MDD are only moderate (41
). Second, self-report of health care utilization is unreliable (43
) and problems with recall and stigma may lead to under reporting. Third, disorder onset and past treatment may be recalled as occurring more recently than it actually occurred (3
). Administrative records would have provided more reliable information concerning depression treatment. Fourth, several factors that influence mental health treatment seeking and access, including lifetime income (44
), health insurance (45
), attitudes toward treatment (30
), and geographic location (46
) were not available. Finally, no information was available on the quality or effectiveness of care. Only a minority of adults treated for MDD receive even minimally adequate treatment (47
While a majority of individuals with MDD eventually seek treatment for their symptoms, long delays to first contact are common. Alongside development of model depression care programs (48
), progress is needed to speed the flow into care. In addition to socio-demographic determinants, comorbid psychiatric disorders play an important role in the timing of initial depression treatment contact. As a group, individuals with MDD uncomplicated by comorbid psychiatric disorders are at risk for experiencing especially long delays. Targeted efforts are needed to improve early detection of depression, motivate help-seeking, modify attitudes about treatment, and fortify referral linkages to promote timely depression care.