Time-to-treatment of mental disorders in a community sample of Dutch adolescents. A TRAILS study

Abstract

Aims: Timely recognition and treatment of mental disorders with an onset in childhood and adolescence is paramount, as these are characterized by greater severity and longer persistence than disorders with an onset in adulthood. Studies examining time-to-treatment, also referred to as treatment delay, duration of untreated illness or latency to treatment, and defined as the time between disorder onset and initial treatment contact, are sparse and all based on adult samples. The aim of this study was to describe time-to-treatment and its correlates for any health care professional (any care) and secondary mental health care (secondary care), for a broad range of mental disorders, in adolescents.

Methods: Data from the Dutch community-based cohort study TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2230) were used. The Composite International Diagnostic Interview (CIDI) was administered to assess DSM-IV disorders, the age of onset, and the age of initial treatment contact with any health care professional in 1584 adolescents of 18-20 years old. In total 43% of the adolescents (n = 675) were diagnosed with a lifetime DSM-IV disorder. The age of initial treatment contact with secondary care was based on administrative records from 321 adolescents without a disorder onset before the age of 10. Descriptive statistics, cumulative lifetime probability plots, and Cox regression analyses were used analyze time-to-treatment.

Results: The proportion of adolescents who reported lifetime treatment contact with any care varied from 15% for alcohol dependence to 82% for dysthymia. Regarding secondary care, proportions of lifetime treatment contact were lower for mood disorders and higher for substance dependence. Time-to-treatment for any care varied considerably between and within diagnostic classes. The probability of lifetime treatment contact for mood disorders was above 90%, whereas for other mental disorders this was substantially lower. An earlier age of onset predicted a longer, and the presence of a co-morbid mood disorder predicted a shorter time-to-treatment in general. Disorder severity predicted a shorter time-to-treatment for any care, but not for secondary care. Time-to-treatment for secondary care was shorter for adolescents from low and middle socioeconomic background than for adolescents from a high socioeconomic background.

Conclusion: Although the time-to-treatment was shorter for adolescents than for adults, it was still substantial, and the overall patterns were remarkably similar to those found in adults. Efforts to reduce time-to-treatment should therefore be aimed at children and adolescents. Future research should address mechanisms underlying time-to-treatment and its consequences for early-onset disorders in particular.

Keywords: Adolescence; diagnosis; health service research; mental health; survival analysis.

Fig. 1.

Weighted cumulative lifetime treatment probabilities with any health care professional for DSM-IV mood disorders (a), anxiety disorders (b), behavior disorders (c), and substance dependence (d). Notes: Weighted by sex, Child Behavior Checklist cut-offs (normal v. borderline clinical/clinical) and parental SEP. Cases with missing values were assigned the weight 1. Probabilities based on life tables using the Actuarial method. Time-to-treatment for disorders with initial treatment contact after initial symptoms and before the year of onset of the respective full-blown disorder set to 0. DYS: dysthymia; MDD: major depressive disorder; BPD: bipolar disorder types I and II; PDS: panic disorder; GAD: generalized anxiety disorder; AGP: agoraphobia; OCD: obsessive-compulsive disorder; SO: social phobia; SAD: separation anxiety disorder; SP: specific phobia; ADD: attention deficit hyperactivity disorder; ODD: oppositional defiant disorder; DRD: drug dependence; ALD: alcohol dependence.