Common Mental Disorder Diagnosis and Need for Treatment are Not the Same: Findings from the NEMESIS Study.

The study aimed to determine whether some depressive, anxiety, and substance-use (DAS) disorders are mild, transient cases that remit without treatment. The first two waves of the first Netherlands Mental Health Survey and Incidence Study were used (age 18-64 years at baseline; wave two N = 5618). Mental disorders were assessed using CIDI 1.1. Past-year and past-month measures of DAS disorders, health service use, and quality of life were assessed at both waves. Individuals with a past-year DAS disorder who received no prior lifetime treatment were significantly more likely than those who received treatment to: (1) remit from their index disorder(s) without subsequent treatment, (2) be free of comorbid disorders, and (3) not have attempted suicide during follow-up (remission rates: 68.5 versus 32.0 %, respectively, p < 0.001). However, these individuals had lower quality of life compared to healthy individuals. Results were similar for past-month measures. Results show that many people who meet criteria for a DAS disorder remit without treatment. However, the lowered quality of life scores in this group nonetheless underscores the negative impact on the presence of residual symptoms.

Baseline Insurance Status and Risk of Common Mental Disorders: A Propensity-Based Analysis of a Longitudinal U.S. Sample.

OBJECTIVE: Because of pervasive poor general medical and mental health status among patients receiving Medicaid, there has been substantial debate about whether Medicaid, as currently financed and delivered, is better than no insurance. The study aimed to address whether insurance status is associated with the subsequent incidence and persistence of common mental disorders. METHODS: Data came from a nationally representative U.S. population-based longitudinal survey that assessed mental disorders at two time points three years apart. Propensity score methods were used to adjust for potential confounding and to assess the association between three mutually exclusive insurance status groups (no insurance, private insurance only, and Medicaid only) and the subsequent incidence and persistence of mood, anxiety, and substance use disorders for persons ages 18-65 (N=26,410). RESULTS: Compared with private insurance, lack of insurance was associated with higher odds of both the incidence and persistence of substance use disorders and with higher odds of persistence of any mood or anxiety disorder. Compared with having private insurance, having Medicaid insurance was associated with increased odds of persistent mood and anxiety disorders during follow-up. Overall, findings did not significantly differ between the uninsured and Medicaid groups. CONCLUSIONS: The findings do not support prior reports that U.S. adults with Medicaid have worse mental health outcomes than uninsured adults. Lacking insurance may put individuals at higher risk of developing substance use disorders, and uninsured individuals with preexisting mental conditions were more likely to have mood, anxiety, and substance use problems that persist over time.

Reductions in quality of life associated with common mental disorders: results from a nationally representative sample.

OBJECTIVE: Traditional burden-of-disease estimates often exclude personality disorders, which are associated with significant mortality and morbidity. The aim of this study was to estimate the health-related quality of life (HRQoL) and annual population-level quality-adjusted life-year (QALY) losses associated with different mental and physical health conditions. In particular, it sought to quantify the impact of personality disorders on quality of life, at an individual and population level. METHOD: This was a secondary analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US general population collected from 2001 to 2005 (N = 34,653). Health-related quality of life (measured using the Short-Form Health Survey-6D) was the main outcome of interest. Regression analysis assessed the impact of various mental (based on DSM-IV criteria) and physical health conditions on HRQoL scores, and this impact was combined with the prevalence of disorders to estimate the population-level burden of disease. RESULTS: Mood disorders were associated with the highest decrease in HRQoL scores, followed by strokes, psychotic illness, and arthritis (P < .01). The greatest annual population QALY losses were caused by arthritis, mood disorders, and personality disorders. CONCLUSIONS: Quality-adjusted life year losses associated with personality disorders ranked behind only mood disorders and arthritis. Personality disorders were associated with significant reductions in quality of life, despite the fact that they are often excluded from traditional burden of disease estimates.

Mental health issues associated with foot complications of diabetes mellitus.

BACKGROUND: The purpose of this study was to evaluate the effect of foot problems on mental health in diabetic patients and their caregivers. METHODS: Diabetic patients (47 patients with and 49 patients without foot problems), and 21 caregivers of patients with foot problems, completed outcome surveys. Foot problems included ulcers (41 patients [87%]), osteomyelitis (9 patients [19%]), and Charcot foot (8 patients [17%]). RESULTS: In contrast with diabetic patients having no foot problems, diabetic patients with foot problems had, on average, significantly greater symptoms of diabetes (Diabetes Symptom Checklist-2 score), greater depression symptoms (Hospital Anxiety and Depression Scale [HADS]-Depression score), worse health-related quality of life (Medical Outcome Study Short Form 36 [SF-36]: Physical Component Summary score and 6 of 8 subscales), greater pain (Short-Form McGill Pain Questionnaire), and greater suicidal behavior (Suicidal Behaviors Questionnaire-Revised). There were no significant differences in alcohol use (mean Alcohol Use Disorder Identification Test score), anxiety (HADS-Anxiety score), or SF-36 Mental Component Summary score between patients with and without foot problems. Caregivers had marked caregiver burden (average Montgomery Caregiver Burden Assessment score) and frequently had mild to moderate depression and anxiety. CONCLUSIONS: Foot problems are significantly associated with mental health symptoms in diabetic patients and caregivers. This may affect treatment in the foot clinic, outcome, and quality of life.