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Influence of Comorbid Mental Disorders on Time to Seeking Treatment for Major Depressive Disorder

Olfson, Mark, MD, MPH*; Liu, Shang-Min, MS*; Grant, Bridget F., PhD, PhD; Blanco, Carlos, MD, PhD*

doi: 10.1097/MLR.0b013e318241eb5e
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Background: Although treatment of depression has increased in recent years, long delays commonly separate disorder onset from first treatment contact.

Objectives: This study evaluates the effects of psychiatric comorbidities and sociodemographic characteristics on lifetime treatment seeking and speed to first treatment contact for major depressive disorder (MDD).

Measures: A cross-sectional epidemiological survey including retrospective structured assessments of DSM-IV MDD and other psychiatric disorders, respondent age at disorder onset, and age at first treatment contact.

Subjects: A nationally representative sample of 5958 adults aged at least 18 years residing in households and group quarters who met lifetime criteria for MDD.

Data Analysis: The percentage of respondents with lifetime MDD who reported ever seeking treatment is reported overall and stratified by sociodemographic characteristics. Unadjusted and adjusted hazard ratios (AHRs) are presented on time to first depression treatment seeking by sociodemographic characteristics and comorbid psychiatric disorders.

Results: A majority (61.3%) of respondents with MDD reported having sought treatment for depression at some point in their lives. Time to first depression treatment contact was significantly related to the occurrence of comorbid panic disorder [AHR=2.01, 95% confidence interval (CI), 1.69–2.39], generalized anxiety disorder (AHR=1.55; 95% CI, 1.33–1.81), drug dependence (AHR=1.54; 95% CI, 1.06–2.26), dysthymic disorder (AHR=1.54; 95% CI, 1.35–1.76), and posttraumatic stress disorder (AHR=1.34; 95% CI, 1.13–1.59) and inversely related to male sex (AHR=0.74; 95% CI, 0.66–0.82) and black race/ethnicity (AHR=0.69, 95% CI, 0.59–0.81).

Conclusions: Comorbid psychiatric disorders, especially panic, generalized anxiety, substance use, and dysthymic disorders, appear to play an important role in accelerating treatment seeking for MDD. Outreach efforts should include a focus on depressed individuals without complicating psychiatric comorbidities.

*Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY

National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD

The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded, in part, by the Intramural Program, NIAAA, National Institutes of Health, with supplementary funding from the National Institute of Drug Abuse (B.F.G). This study was supported by DA019606, DA020783, DA023200, and MH076051 (C.B.), and U18 HS016097 (M.O.) and the New York State Psychiatric Institute (C.B. and M.O).

Dr Olfson has received grants to Columbia University from Eli Lilly & Company and Bristol Myers Squibb.

The authors declare no conflict of interest.

Reprints: Mark Olfson, MD, MPH, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032. E-mail: mo49@columbia.edu.

© 2012 Lippincott Williams & Wilkins, Inc.