Six-year healthcare trajectories of adults with anxiety and depressive disorders: Determinants of transition to specialised mental healthcare

L. C. Kooistra*, J. E. Wiersma, J. J. Ruwaard, H. Riper, B. W.J.H. Penninx, P. van Oppen

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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Abstract

Background: To investigate potential facilitators and barriers for patients receiving specialised mental healthcare using a longitudinal design. Methods: Longitudinal data on 701 adult participants with a depressive and/or anxiety disorder were derived from the Netherlands Study of Depression and Anxiety (NESDA). Demographic, clinical and treatment determinants at baseline were assessed with self-report questionnaires and the Composite International Diagnostic Interview (CIDI 2.1). Transition to specialised mental healthcare was assessed at one, two, four, and six-year follow-up with a self-report resource use questionnaire (TiC-P). Results: 28.3% of patients with a depressive and/or anxiety disorder transitioned from receiving no care or primary mental healthcare to specialised mental health services during six-year follow-up. The multivariate Cox regression model identified suicidal ideation, younger age, higher education level, openness to experience, pharmacological treatment, prior treatment in primary mental healthcare and perceived unmet need for help as determinants of transition, explaining 8–18% of variance. Limitations: This study focused on baseline determinants of future transition to specialised mental healthcare. Recovery and remittance of depression and anxiety in relation to transition were not studied. Conclusions: Not all key clinical guideline characteristics such as severity of symptoms and comorbidity were predictive of a transition to specialised mental healthcare, while non-clinical factors, such as age and perceived unmet need for help, did influence the process.

Original languageEnglish
Pages (from-to)226-234
Number of pages9
JournalJournal of Affective Disorders
Volume241
Early online date24 Jul 2018
DOIs
Publication statusPublished - 1 Dec 2018

Funding

The infrastructure for the NESDA study ( www.nesda.nl ) is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (ZonMw, grant number 10-000-1002 ) and financial contributions by participating universities and mental healthcare organizations (VU University Medical Center, GGZ inGeest, Leiden University Medical Center, Leiden University, GGZ Rivierduinen, University Medical Center Groningen, University of Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Rob Giel Onderzoekscentrum).

Keywords

  • Anxiety
  • Depression
  • Determinants
  • Specialised mental healthcare

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