Australians will wait an average of 12 years before getting treatment for mental health or substance use disorders, according to a new study. While the findings are rather grim, the study did find that younger people are much more likely to seek help for their mental health when they need it.
It’s trite to say that conditions that affect mental health cause great suffering to not only the individual with the condition but also their loved ones. In addition, they’re prevalent. A recent study found that half the world’s population will experience a mental health disorder by the time they turn 75.
In and of themselves, those findings are alarming. However, the findings of a new study by researchers at the Matilda Center for Research in Mental Health and Substance Use at The University of Sydney (USyd), which looked at how long it took people to seek treatment for a mental or substance use disorder (SUD), might be more alarming still.
“While most individuals with mental disorders eventually seek treatment, this varies considerably across individual disorders, and the delays from initial disorder onset to first seeking treatment can be extensive,” said the researchers. “Despite being a high-income country with considerable resources, Australians are waiting an average of 12 years before seeking treatment for a mental or SUD.”
The researchers examined data from 15,893 people who participated in the 2020-2022 Australian National Study of Mental Health and Wellbeing (NSMHW). They assessed lifetime diagnoses made under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in the following general categories:
- Mood disorders (major depressive disorder, bipolar disorder, dysthymia, mania).
- Anxiety disorders (agoraphobia with or without panic, panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder).
- Substance use disorders (alcohol use disorder, drug use disorder).
For each disorder, participants were asked at what age they first experienced symptoms (termed ‘age-of-onset’). ‘Age of first treatment contact’ was determined by asking if participants had ever consulted a medical doctor or other professional about symptoms of a particular disorder and, if so, how old they were when they first did so. Treatment delay was then estimated for each of the disorders listed above, defined as the time, in years, between age-of-onset and age of first treatment contact.
In terms of general classes of disorders, people with SUDs were least likely to eventually seek treatment over their lifetime, with a projected probability of 27%. In contrast, 85% of people with any anxiety disorder and almost all people (94%) with a mood disorder were projected to make treatment contact. Of those who sought treatment, those with anxiety disorders waited the longest, an average of 11 years, followed by those with SUDs (eight years on average). The group with the shortest delay in seeking treatment were those with mood disorders: an average of three years.
When the researchers looked at participants who made treatment contact in the first year of symptom onset, they saw wide variations across individual disorders. The highest was for panic disorder (37%), and the lowest was for alcohol use disorder (2%). The expected lifetime treatment rates also varied across disorders, from 25% for alcohol use disorder to 94% for major depressive disorder. Participants with symptoms of panic disorder and bipolar disorder eventually sought treatment within a relatively speedy two years of the onset of those symptoms. Whereas people with social anxiety disorder waited an astonishing 13 years on average.
Factors associated with participants’ delay in seeking treatment included sex at birth, age, and education. Compared to males, females showed significantly higher odds of seeking treatment, with shorter treatment delays for any mood disorder or anxiety disorder. However, they had significantly lower odds of seeking treatment for any SUD compared to males.
In terms of age, Millennials and those from Gen Z – born between 1992 and 2005 – were over four times more likely to seek treatment for a SUD, over two times more likely for a mood disorder, and nearly four times as likely for an anxiety disorder, compared to Gen Xers born before 1972.
“This positive trend suggests current generations of young people are more inclined to seek timely treatment than their parents’ generation,” the researchers said. “It could be speculated that increased education, often embedded through schools, in conjunction with national mental health literacy campaigns targeted at young people, as well as more easily accessible online information, could also be contributors to this cohort effect.”
While there was little evidence associating education level with treatment delay for SUD, it was significantly associated with treatment delay for mood disorders and anxiety disorders. Participants with a higher level of education had greater odds of seeking treatment.
The study’s limitations include the fact that the data used by the researchers relied on participants’ recall and self-reporting. Further, data collection for the NSMHW occurred during the COVID-19 pandemic, which was accompanied by a steep rise in anxiety and depression globally. Although, the potential impact of COVID-19 might not be too significant, given that participants were asked about their mental health experiences across their entire lifetime. Some mental health issues – eating disorders and psychosis, for example – were not included in the NSMHW. Despite these limitations, this study is the first and most comprehensive study examining the delay in seeking mental health treatment and the factors associated with that delay.
While these findings reveal a lengthy delay in seeking mental health treatment, how do they stack up compared to other countries? A 2007 study based on data from the World Health Organization’s (WHO) World Mental Health Survey Initiative indicates that Australia might just be faring better. The median delay in that study ranged from three to 30 years for anxiety disorders, one to 14 years for mood disorders, and six to 18 years for SUD. The study included 76,012 adult participants from Belgium, China, Colombia, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, Spain, and the US.
The researchers pointed to some of the reasons people might delay getting help. Practical reasons include the unavailability of services in some areas, particularly rural and regional areas, and high out-of-pocket expenses that disadvantage society’s vulnerable. Fear and stigma are also very important considerations, as is simply knowing what services are available. Seeking treatment can be difficult. However, research has shown that delaying treatment can result in a more complex, more severe illness.
The study was published in the journal Epidemiology and Psychiatric Sciences.
Source: The University of Sydney
