Mental health service use in a nationwide sample of Korean adults

Introduction An understanding of the factors leading to the use of mental health services is important in improving access to mental health-care. The purpose of this study was to assess the use of mental health services, determinants of use and barriers to use. Methods Data were derived from a representative sample of the general population, aged 18-64 years. The Korean version of the Composite International Diagnostic Interview was used for the purpose of psychiatric assessment. Respondents were also asked about their use of mental health services, and about any experience of barriers to services. The response rate was 80.2%, and a total of 6,275 persons participated in the study. Results Of the respondents who completed the interview (n = 6,275), 1.9% reported the use of mental health services during the past 12 months. Of the respondents who met the criteria for the 1-year diagnosis of a psychiatric disorder (n = 916), 6.1% received mental health-care. Age, unemployment, and medical assistance (public assistance) were correlated positively with frequency of mental health-care. Of those who suffered from a psychiatric disorder but did not seek consultation (n = 836), 23.4% said that they desired to handle the problem on their own, and 23% asserted that they had no psychiatric disorder. Conclusions The high rate of non-consultation among those with psychiatric disorders constitutes an important public health problem. Public health efforts to narrow the gap in service delivery are crucial. Also, additional efforts are warranted to address barriers to mental health care to develop an efficient mental health-care system.Williams DR, 2008, PSYCHOL MED, V38, P211, DOI 10.1017/S0033291707001420Druss BG, 2007, ARCH GEN PSYCHIAT, V64, P1196Wang PS, 2007, LANCET, V370, P841, DOI 10.1016/S0140-6736(07)61414-7Elhai JD, 2007, PSYCHIAT SERV, V58, P1108Judd F, 2007, AUSTRALAS PSYCHIATRY, V15, P185, DOI 10.1080/10398560601123724Jang YR, 2007, J AM GERIATR SOC, V55, P616, DOI 10.1111/j.1532-5415.2007.01125.xCho MJ, 2007, J NERV MENT DIS, V195, P203, DOI 10.1097/01.nmd.0000243826.40732.45Steele L, 2007, CAN J PSYCHIAT, V52, P201Honkonen T, 2007, SCAND J WORK ENV HEA, V33, P29Abe-Kim J, 2007, AM J PUBLIC HEALTH, V97, P91Levinson D, 2007, ISR J PSYCHIATR REL, V44, P114Fenta H, 2006, J NERV MENT DIS, V194, P925, DOI 10.1097/01.nmd.0000249109.71776.58SEO MK, 2006, J KOREAN NEUROPSYCHI, V44, P371Barney LJ, 2006, AUST NZ J PSYCHIAT, V40, P51Gureje O, 2006, SOC PSYCH PSYCH EPID, V41, P44, DOI 10.1007/s00127-005-0001-7Kessler RC, 2005, NEW ENGL J MED, V352, P2515, DOI 10.1056/NEJMsa043266DRAPEAU A, 2005, CANADIAN J PSYCHIAT, V50, P599Saldivia S, 2004, PSYCHIAT SERV, V55, P71PAKR K, 2003, J KOREAN ACAD FAM ME, V24, P328CHO MJ, 2002, J KOREAN NEUROPSYCHI, V41, P123Andrews G, 2001, BRIT J PSYCHIAT, V178, P145Kessler RC, 1999, AM J PSYCHIAT, V156, P115Swartz MS, 1998, COMMUNITY MENT HLT J, V34, P133*WHO, 1997, COMP INT DIAGN INT VSHAH BV, 1997, SUDAAN USERS MANUALLin E, 1996, CAN J PSYCHIAT, V41, P572MELTZER H, 1995, PHYS COMPLAINTS SERVCROW MR, 1994, J MENT HEALTH ADMIN, V21, P5KESSLER RC, 1994, ARCH GEN PSYCHIAT, V51, P8WITTCHEN HU, 1994, J PSYCHIAT RES, V28, P57*AM PSYCH ASS, 1994, DIAGN STAT MAN MENTJOSEPH AE, 1993, SOC SCI MED, V37, P813REGIER DA, 1993, ARCH GEN PSYCHIAT, V50, P85HANSSON L, 1992, ACTA PSYCHIAT SCAND, V86, P255OLFSON M, 1992, SOC PSYCH PSYCH EPID, V27, P161BLAND RC, 1990, CAN J PSYCHIAT, V35, P397KEELER EB, 1988, J HEALTH ECON, V7, P369WELLS KB, 1988, MED CARE, V26, P441KESSLER LG, 1987, AM J PUBLIC HEALTH, V77, P18TAUBE CA, 1986, HEALTH SERV RES, V21, P321LEAF PJ, 1985, MED CARE, V23, P1322HORGAN CM, 1985, ARCH GEN PSYCHIAT, V42, P565MANNING WG, 1984, AM PSYCHOL, V39, P1077SUE S, 1977, AM PSYCHOL, V32, P616

Cross-national difference in the prevalence of depression caused by the diagnostic threshold

BACKGROUND: According to published reports, the prevalence rates of major depressive disorder (MDD) in East-Asian countries are lower than in the West, but the reasons for this difference have not been fully investigated. METHODS: This study compared the Korean Epidemiologic Catchment Area study (KECAS) sample with the National Comorbidity Survey (NCS, USA) sample. In total, this study included 5349 participants in KECAS and 7423 in NCS aged 18-54 years. The Composite International Diagnostic Interview (CIDI) assessed for MDD. Analysis of the individual symptoms of MDD was completed. RESULTS: Diagnostic threshold of MDD was higher in KECAS participants than in NCS participants. Koreans diagnosed with MDD showed more work impairment than Americans with MDD. Koreans were more likely to express the symptoms like "low energy" and "concentration difficulty," but less to the symptoms like "depressed mood" and "thoughts of death" during an episode of MDD. LIMITATIONS: The Diagnostic and Statistical Manual of Mental Disorders (DSM) framework was the basis for the majority of the comparisons made in this study. Various depressive symptoms not included in the DSM framework were unlikely to be detected. CONCLUSIONS: Cross-cultural differences in rates of MDD are attributable to diagnostic thresholds. Symptom patterns and forms of depression in Korea, as defined by the DSM framework, are not identical to those in the U.S