Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

Christine Geyti, Kaj Sparle Christensen, Else-Marie Dalsgaard, Bodil Hammer Bech, Jane Gunn, Helle Terkildsen Maindal, Annelli Sandbaek, Christine Geyti, Kaj Sparle Christensen, Else-Marie Dalsgaard, Bodil Hammer Bech, Jane Gunn, Helle Terkildsen Maindal, Annelli Sandbaek

Abstract

Introduction: Poor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients' mental health status may improve the identification of cases in need of mental healthcare.

Objectives: To investigate the extent of initiation of mental healthcare after identification of poor mental health and to identify factors associated with non-initiation.

Design: Prospective cohort study with 1-year follow-up.

Setting: In a population-based health preventive programme, Check Your Health, we conducted a combined mental and physical health check in Randers Municipality, Denmark, in 2012-2015 in collaboration with local GPs.

Participants: Participants were 350 individuals aged 30-49 years old with screen-detected poor mental health who had not received mental healthcare within the past year. The cohort was derived from 14 167 randomly selected individuals of whom 52% (n=7348) participated. Mental health was assessed by the mental component summary score of the 12-item Short-Form Health Survey.

Outcome: The outcome was initiation of mental healthcare. Mental healthcare included psychometric testing by GP, talk therapy by GP, contact with a psychologist, contact with a psychiatrist and psychotropic medication.

Results: Within 1 year, 22% (95% CI 18 to 27) of individuals with screen-detected poor mental health initiated mental healthcare. Among individuals who initiated mental healthcare within follow-up, one in six had visited their GP once or less in the preceding year. Male sex (OR: 0.49 (95% CI 0.28 to 0.86)) and less impaired mental health (OR: 0.93 (95% CI 0.89 to 0.98)) were associated with non-initiation of mental healthcare. We found no overall association between socioeconomic factors and initiating mental healthcare.

Conclusion: Systematic provision of mental health test results to GPs may improve the identification of cases in need of mental healthcare, but does not translate into initiation of mental healthcare. Further research should focus on methods to improve initiation of mental healthcare, especially among men.

Trial registration number: NCT02028195.

Keywords: mental health; primary care; public health.

Conflict of interest statement

Competing interests: JG reports personal fees from the Eastern Melbourne Primary Health Network (outside the submitted work).

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of study population. Check Your Health: a health preventive programme with a combined mental and physical health check, 2012–2015. Mental healthcare: psychometric test by general practitioner (GP), talk therapy by GP, contact with a psychologist, psychotropic medication or contact with a psychiatrist. Poor mental health: mental component summary score of ≤35.76 (12-item Short-Form Health Survey, V.2, US norms of 1998).
Figure 2
Figure 2
Factors associated with initiation and non-initiation of mental healthcare after health check (N=350). Adjusted ORs. Participants of the Check Your Health preventive programme in 2012–2015 with screen-detected poor mental health who had not received mental healthcare within the year preceding the health check. Age is adjusted for sex, education and cohabitation. Sex is adjusted for age, education and cohabitation. Education, occupation and income are adjusted for sex, age and cohabitation. All other explanatory variables are adjusted for sex, age, education and cohabitation. Red flags at the health check: any red flag besides poor mental health screening result: poor/fair self-rated health (SF-12 item 1); alcohol risk behaviour (CAGE-C (≥2 positive answers to items 1–4 and 6, or one positive answer to items 1–4 and 6, plus alcohol intake on ≥4 days per week), AUDIT score ≥8 or ≥21 number of alcohol units per week (men), or AUDIT score ≥8 or ≥14 number of alcohol units per week (women)); high CVD/DM risk profile (systolic BP ≥140, diastolic BP ≥95, HbA1c ≥6.0%, total cholesterol ≥6 mmol/L, LDL ≥6 mmol/L or 10-year risk of fatal CVD ≥5%); and reduced lung function (FEV1 or FVC ≤80% or FEV1/FVC ≤0.70). (Part of the figure was made with Stata V.15.1 software on the remote server of Statistics Denmark. Downloaded with permission from Statistics Denmark.) AUDIT, Alcohol Use Disorders Identification Test; BP, blood pressure; CAGE-C, Cut down, Annoyed, Guilty, Eye-opener (Copenhagen); CVD, cardiovascular disease; DM, diabetes mellitus; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; MCS, mental component summary; SF-12, 12-item Short-Form Health Survey.

References

    1. World Health Organization, Regional Office for Europe The European mental health action plan 2013–2020. Copenhagen: World Health Organization, 2015.
    1. Whiteford HA, Degenhardt L, Rehm J, et al. . Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet 2013;382:1575–86. 10.1016/S0140-6736(13)61611-6
    1. Moussavi S, Chatterji S, Verdes E, et al. . Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet 2007;370:851–8. 10.1016/S0140-6736(07)61415-9
    1. Ferrari AJ, Charlson FJ, Norman RE, et al. . Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013;10:e1001547. 10.1371/journal.pmed.1001547
    1. Pinto-Meza A, Moneta MV, Alonso J, et al. . Social inequalities in mental health: results from the EU contribution to the world mental health surveys initiative. Soc Psychiatry Psychiatr Epidemiol 2013;48:173–81. 10.1007/s00127-012-0536-3
    1. Gustavsson A, Svensson M, Jacobi F, et al. . Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:718–79. 10.1016/j.euroneuro.2011.08.008
    1. Region Midtjylland [Central Denmark Region] Psykiatriplan: Bedre behandling og længere liv til flere med psykisk sygdom på patientens præmisser - Psykiatriplan for Region Midtjylland 2017 [Psychiatry plan: Better treatment and longer life to more patients with psychiatric disease on the patient’s terms - Psychiatry plan for Central Denmark Region 2017. Central Denmark Region: Viborg, 2017.
    1. Ohayon MM, Priest RG, Guilleminault C, et al. . The prevalence of depressive disorders in the United Kingdom. Biol Psychiatry 1999;45:300–7. 10.1016/s0006-3223(98)00011-0
    1. Ministry of Health Partnerskabsaftale "Mental sundhed på arbejdspladsen" [Partnership agreement "Mental health at the workplace". Copenhagen: Ministry of Health, 2016.
    1. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:609. 10.1016/S0140-6736(09)60879-5
    1. Cassano P, Fava M. Depression and public health: an overview. J Psychosom Res 2002;53:849–57. 10.1016/s0022-3999(02)00304-5
    1. Gilbody S, Sheldon T, House A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ 2008;178:997–1003. 10.1503/cmaj.070281
    1. Gidding LG, Spigt M, Winkens B, et al. . PsyScan e-tool to support diagnosis and management of psychological problems in general practice: a randomised controlled trial. Br J Gen Pract 2018;68:e18–27. 10.3399/bjgp17X694109
    1. Palmer SC, Coyne JC. Screening for depression in medical care: pitfalls, alternatives, and revised priorities. J Psychosom Res 2003;54:279–87. 10.1016/s0022-3999(02)00640-2
    1. Christensen KS, Sokolowski I, Olesen F. Case-Finding and risk-group screening for depression in primary care. Scand J Prim Health Care 2011;29:80. 10.3109/02813432.2011.554009
    1. MaGPIe Research Group The effectiveness of case-finding for mental health problems in primary care. Br J Gen Pract 2005;55:665–9.
    1. Siu AL, Bibbins-Domingo K, et al. , US Preventive Services Task Force (USPSTF) . Screening for depression in adults: US preventive services Task force recommendation statement. JAMA 2016;315:380–7. 10.1001/jama.2015.18392
    1. Packness A, Halling A, Hastrup LH, et al. . Socioeconomic position, symptoms of depression and subsequent mental healthcare treatment: a Danish register-based 6-month follow-up study on a population survey. BMJ Open 2018;8:e020945. 10.1136/bmjopen-2017-020945
    1. Williams JB, Spitzer RL, Linzer M, et al. . Gender differences in depression in primary care. Am J Obstet Gynecol 1995;173:654–9. 10.1016/0002-9378(95)90298-8
    1. Rost K, Nutting P, Smith J, et al. . Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. quality enhancement by strategic Teaming. J Gen Intern Med 2001;16:143–9. 10.1111/j.1525-1497.2001.00537.x
    1. Ten Have M, Nuyen J, Beekman A, et al. . Common mental disorder severity and its association with treatment contact and treatment intensity for mental health problems. Psychol Med 2013;43:2203. 10.1017/S0033291713000135
    1. Bruffaerts R, Posada-Villa J, Al-Hamzawi AO, et al. . Proportion of patients without mental disorders being treated in mental health services worldwide. Br J Psychiatry 2015;206:101–9. 10.1192/bjp.bp.113.141424
    1. Bijl RV, Ravelli A. Psychiatric morbidity, service use, and need for care in the general population: results of the Netherlands mental health survey and incidence study. Am J Public Health 2000;90:602–7. 10.2105/ajph.90.4.602
    1. Packness A, Waldorff FB, Christensen RdePont, et al. . Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study. Soc Psychiatry Psychiatr Epidemiol 2017;52:1405–13. 10.1007/s00127-017-1437-2
    1. Boerema AM, Ten Have M, Kleiboer A, et al. . Demographic and need factors of early, delayed and NO mental health care use in major depression: a prospective study. BMC Psychiatry 2017;17:367. 10.1186/s12888-017-1531-8
    1. Kessler RC, Angermeyer M, Anthony JC, et al. . Lifetime prevalence and age-of-onset distributions of mental disorders in the world Health organization's world mental health survey initiative. World Psychiatry 2007;6:168–76.
    1. Maindal HT, Støvring H, Sandbaek A. Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial. Trials 2014;15:341. 10.1186/1745-6215-15-341
    1. Pedersen CB. The Danish civil registration system. Scand J Public Health 2011;39:22–5. 10.1177/1403494810387965
    1. Ware J, Kosinski M, Keller SD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220–33. 10.1097/00005650-199603000-00003
    1. Ware JE, Kosinski M, Turner-Bowker DM, et al. . User’s manual for the SF-12v2® health survey with a supplement documenting the SF-12® health survey. QualityMetric incorporated: Lincoln, RI, 2002.
    1. Christensen LN, Ehlers L, Larsen FB, et al. . Validation of the 12 item short form health survey in a sample from region central Jutland. Soc Indic Res 2013;114:513–21. 10.1007/s11205-012-0159-9
    1. Kontodimopoulos N, Pappa E, Niakas D, et al. . Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes 2007;5:55. 10.1186/1477-7525-5-55
    1. Gill SC, Butterworth P, Rodgers B, et al. . Validity of the mental health component scale of the 12-Item short-form health survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Res 2007;152:63–71. 10.1016/j.psychres.2006.11.005
    1. Kiely KM, Butterworth P. Validation of four measures of mental health against depression and generalized anxiety in a community based sample. Psychiatry Res 2015;225:291–8. 10.1016/j.psychres.2014.12.023
    1. Christensen AI, Davidsen M, Kjøller M, et al. . Mental sundhed blandt voksne danskere: analyser baseret på sundheds- og sygelighedsundersøgelsen 2005 [Mental health among adult Danes: analyses based on the Danish health and morbidity survey 2005. Copenhagen: The Danish Health Authority, 2010: 90.
    1. Christiansen T. Organization and financing of the Danish health care system. Health Policy 2002;59:107–18. 10.1016/s0168-8510(01)00201-9
    1. Andersen JS, Olivarius NDF, Krasnik A. The Danish National health service register. Scand J Public Health 2011;39:34–7. 10.1177/1403494810394718
    1. Lynge E, Sandegaard JL, Rebolj M. The Danish national patient register. Scand J Public Health 2011;39:30–3. 10.1177/1403494811401482
    1. Kildemoes HW, Sørensen HT, Hallas J. The Danish national prescription registry. Scand J Public Health 2011;39:38–41. 10.1177/1403494810394717
    1. Perk J, De Backer G, Gohlke H, et al. . European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint Task force of the European Society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635. 10.1093/eurheartj/ehs092
    1. Zierau F, Hardt F, Henriksen JH, et al. . Validation of a self-administered modified cage test (CAGE-C) in a somatic Hospital ward: comparison with biochemical markers. Scand J Clin Lab Invest 2005;65:615–22. 10.1080/00365510500333445
    1. Saunders JB, Aasland OG, Babor TF, et al. . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction 1993;88:791–804. 10.1111/j.1360-0443.1993.tb02093.x
    1. Statistics Denmark Data for research Copenhagen: statistics Denmark. Available: [Accessed 11 Aug 2020].
    1. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen's behavioral model of health services use: a systematic review of studies from 1998-2011. Psychosoc Med 2012;9:Doc11. 10.3205/psm000089
    1. Unesco International standard classification of education 1997. United Nations Educational, Scientific and Cultural Organization, 1997.
    1. OECD Mental health and work: Denmark. Paris: OECD Publishing, 2013.
    1. Helweg-Larsen K. The Danish register of causes of death. Scand J Public Health 2011;39:26–9. 10.1177/1403494811399958
    1. Statistics Denmark Guidelines for transferring aggregated results from Statistics Denmark’s research services, 2015.
    1. European Commission Communication from the commission to the European parliament and the council. Stronger protection, new opportunities - Commission guidance on the direct application of the General Data Protection Regulation as of 25 May 2018. Brussels: European Commission, 2018.
    1. Westreich D, Greenland S. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol 2013;177:292–8. 10.1093/aje/kws412
    1. Shavers VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 2007;99:1013.
    1. Steele L, Dewa C, Lee K. Socioeconomic status and self-reported barriers to mental health service use. Can J Psychiatry 2007;52:201–6. 10.1177/070674370705200312
    1. Möller-Leimkühler AM. Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affect Disord 2002;71:1–9. 10.1016/s0165-0327(01)00379-2
    1. Bjerregaard A-L, Maindal HT, Bruun NH, et al. . Patterns of attendance to health checks in a municipality setting: the Danish 'Check Your Health Preventive Program'. Prev Med Rep 2017;5:175–82. 10.1016/j.pmedr.2016.12.011
    1. Have Mten, Oldehinkel A, Vollebergh W, et al. . Does educational background explain inequalities in care service use for mental health problems in the Dutch general population? Acta Psychiatr Scand 2003;107:178–87. 10.1034/j.1600-0447.2003.00074.x
    1. Korkeila J, Lehtinen V, Bijl R, et al. . Establishing a set of mental health indicators for Europe. Scand J Public Health 2003;31:451–9. 10.1080/14034940210165208
    1. McDaid D. Countering the stigmatisation and discrimination of people with mental health problems in Europe. European Commission, 2010.
    1. Andrade LH, Alonso J, Mneimneh Z, et al. . Barriers to mental health treatment: results from the who world mental health surveys. Psychol Med 2014;44:1303–17. 10.1017/S0033291713001943
    1. Hutton C, Gunn J. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review. BMC Health Serv Res 2007;7:71. 10.1186/1472-6963-7-71
    1. Sanderson K, Andrews G. Prevalence and severity of mental health-related disability and relationship to diagnosis. Psychiatr Serv 2002;53:80. 10.1176/appi.ps.53.1.80
    1. Geyti C, Dalsgaard E-M, Sandbæk A, et al. . Initiation and cessation of mental healthcare after mental health screening in primary care: a prospective cohort study. BMC Fam Pract 2018;19:176. 10.1186/s12875-018-0864-9
    1. Richards JC, Ryan P, McCabe MP, et al. . Barriers to the effective management of depression in general practice. Aust N Z J Psychiatry 2004;38:795–803. 10.1080/j.1440-1614.2004.01464.x
    1. Larsen FB, Friis K, Lasgaard M. Hvordan har du det? 2013 - Sundhedsprofil for region og kommuner (Bind 1) [How are you? 2013 - Health profile for region and municipalities (vol. 1. Aarhus, 2014.
    1. Coghill N, Garside L, Montgomery AA, et al. . Nhs health checks: a cross- sectional observational study on equity of uptake and outcomes. BMC Health Serv Res 2018;18:238. 10.1186/s12913-018-3027-8
    1. Bender AM, Jørgensen T, Helbech B, et al. . Socioeconomic position and participation in baseline and follow-up visits: the Inter99 study. Eur J Prev Cardiol 2014;21:899–905. 10.1177/2047487312472076
    1. Hoebel J, Starker A, Jordan S, et al. . Determinants of health check attendance in adults: findings from the cross-sectional German health update (GEDA) study. BMC Public Health 2014;14:913. 10.1186/1471-2458-14-913
    1. Dryden R, Williams B, McCowan C, et al. . What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 2012;12:723. 10.1186/1471-2458-12-723
    1. Seidler ZE, Dawes AJ, Rice SM, et al. . The role of masculinity in men's help-seeking for depression: a systematic review. Clin Psychol Rev 2016;49:106–18. 10.1016/j.cpr.2016.09.002
    1. Matcham F, Norton S, Steer S, et al. . Usefulness of the SF-36 health survey in screening for depressive and anxiety disorders in rheumatoid arthritis. BMC Musculoskelet Disord 2016;17:224. 10.1186/s12891-016-1083-y
    1. Wells MJ, Owen JJ, McCray LW, et al. . Computer-Assisted Cognitive-Behavior therapy for depression in primary care: systematic review and meta-analysis. Prim Care Companion CNS Disord 2018;20. 10.4088/PCC.17r02196. [Epub ahead of print: 01 Mar 2018].
    1. Archer J, Bower P, Gilbody S, et al. . Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012;10:CD006525. 10.1002/14651858.CD006525.pub2
    1. de Lusignan S, Chan T, Parry G, et al. . Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison. J Epidemiol Community Health 2012;66:e10. 10.1136/jech.2011.139873

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi