Are Individuals with Poor Mental Health Under-treated? Findings from a Population-Based Study in six Texas' counties

Background: About 25% of adults in the United States suffer from mental ill-health, with mood and anxiety disorders being the most prevalent mental illnesses. Our study objectives were to estimate the population-based prevalence rates of depression and anxiety, as well as the treatment rates of adults with poor mental health in selected Texas counties.

Methods: We selected at least 385 adult respondents (18 years and older), each from 6 counties in Texas, using a probability-based dual-frame random digit dialing technique. The sampled counties, which differed by socio-demographic, geographic, and urbanization characteristics, were – Hale and Lubbock (west Texas); McLennan (central Texas); Jim-Wells, Webb, and Willacy (south Texas). Respondents were surveyed by computer-assisted telephone interviews between September and November 2012. Poor mental health was assessed by measuring the parameter of frequent mental distress (FMD). FMD was defined as having at least 14 days of mental ill-health in the prior 30-day period. Lifetime prevalence rates of depression and anxiety, as well as the point prevalence rates of FMD and treatment for mental/emotional problems, were determined from respondents’ self-report. The corresponding population-based prevalence rate, and confidence interval (CI) estimates were obtained by applying sampling weights accounting for the sample design, non-response, and post-stratification.

Results: There were 2,330 respondents in our study and the weighted aggregate was 622,066 adults in the 6 counties. The prevalence rates of FMD were 4.6% (95% CI: 2.68, 6.50) in west Texas, 6.8% in south Texas (95% CI: 4.37, 9.17), and 11.1% (95% CI: 5.36, 16.90) in central Texas. Among adults with FMD in these counties, 79.6% (95% CI: 69.3, 89.9) had a lifetime history of diagnosis with either depression or anxiety. 74% (95% CI: 58.7, 90.9) of those with FMD also reported having had a routine medical check-up within the past year. However, only 41.2% (95% CI: 27.4, 55.0) of those with FMD were receiving medications or treatment for any mental or emotional health problem.

Conclusion: The majority of adults with poor mental health in our study population reported having been diagnosed with either depression or anxiety. However, less than half of those with poor mental health may be receiving any form of treatment, even though the majority of them would have had a routine medical visit within the past year. Routine medical visits present windows for physicians and healthcare providers to screen patients with mental disorders for mental distress, and treat or refer them as clinically indicated.