[Epidemic of depression? : Development of prevalence and help-seeking behaviour]

Abstract

Background: While national health insurance companies in Germany have reported increasing frequencies of depression and growing costs since the first reports approximately 20 years ago, the prevalence from epidemiological field studies has remained stable in the general population. This study examined time trends in help-seeking behaviour for depression based on data from the German health monitoring programme at the Robert Koch Institute.

Methods: Data were obtained from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, 18-65 years, n = 3320) and the mental health supplement of the German National Health Interview and Examination Survey 1998 (GHS-MHS, 1997-1999; 18-65 years, n = 4181). Persons with 12-month major depressive disorder standardized according to DSM IV were identified based on the WHO Composite International Diagnostic Interview (CIDI) and asked for information on service utilization due to mental health problems by type of sector and service provider (GHS-MHS: n = 346, DEGS1-MH: n = 229).

Results: Overall, there were no significant time trends with respect to self-reported service utilization. Help seeking by men with depression increased in making contact with respect to psychotherapy and psychology options. Worrying about stigmatization and lack of knowledge about professional help were identified as individual barriers for help seeking and nearly one quarter reported access barriers.

Conclusion: Overall, increasing frequencies of depression in the German healthcare system cannot be solely attributed to changes in help-seeking behavior of people with depression. Self-reported barriers of service utilization and divergences between primary and secondary data indicate the need of further evaluation and optimization of mental healthcare provision in Germany.

Keywords: Depression; Germany; Public Health; Service utilization; Time trends.