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Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Care | Research article

Trends in psychiatric diagnoses, medications and psychological therapies in a large Swedish region: a population-based study

Authors: T. Forslund, K. Kosidou, S. Wicks, C. Dalman

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

Health services utilization for mental health disorders is reported to increase sharply in many countries. The aim of this study was to report trends in all aspects of mental health care utilization in a total population sample.

Methods

Repeated cross-sectional register study of the Stockholm Region (VAL) including both primary and secondary care. Trends in the proportion of adults in the total population of Stockholm Region with a recorded ICD-10 psychiatric diagnosis or psychological therapy during 2007–2017 as well as claims of psychiatric medication from 2011 were calculated.

Results

The proportion of adults utilizing any mental health care increased from 13.2% in 2011 to 16.1% in 2017. In 2017, 49.3% were treated in primary care, 32.2% in secondary care and 18.5% were jointly managed. The increase was most pronounced in younger adults. Women were more likely to receive mental health care than men in all ages. Medication decreased from 71.0 to 67.7%, while psychological therapy increased from 33.1 to 37.6%. The use of psychiatric medication increased with age while psychological therapy decreased. All time trends were statistically significant (p < .0001).

Conclusion

Care for mental health disorders has been increasing mainly in primary care and was delivered to one in seven adult individuals in 2017. Interventions are needed to address the growing burden of mental health disorders while avoiding overtreatment.
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Literature
1.
go back to reference Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382:1575–86.CrossRef Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382:1575–86.CrossRef
2.
go back to reference Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK biobank: development, implementation and results from an online questionnaire completed by 157 366 participants. BJPsych Open. 2018;4:83–90.CrossRef Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK biobank: development, implementation and results from an online questionnaire completed by 157 366 participants. BJPsych Open. 2018;4:83–90.CrossRef
3.
go back to reference Olfson M, Druss BG, Marcus SC. Trends in mental health care among children and adolescents. N Engl J Med. 2015;372:2029–38.CrossRef Olfson M, Druss BG, Marcus SC. Trends in mental health care among children and adolescents. N Engl J Med. 2015;372:2029–38.CrossRef
4.
go back to reference Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71:81–90.CrossRef Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71:81–90.CrossRef
5.
go back to reference Kosidou K, Magnusson C, Mittendorfer-Rutz E, Hallqvist J, Hellner Gumpert C, Idrizbegovic S, Dal H, Dalman C. Recent time trends in levels of self-reported anxiety, mental health service use and suicidal behaviour in Stockholm. Acta Psychiatr Scand. 2010;122:47–55.CrossRef Kosidou K, Magnusson C, Mittendorfer-Rutz E, Hallqvist J, Hellner Gumpert C, Idrizbegovic S, Dal H, Dalman C. Recent time trends in levels of self-reported anxiety, mental health service use and suicidal behaviour in Stockholm. Acta Psychiatr Scand. 2010;122:47–55.CrossRef
6.
go back to reference Sigfusdottir ID, Asgeirsdottir BB, Sigurdsson JF, Gudjonsson GH. Trends in depressive symptoms, anxiety symptoms and visits to healthcare specialists: a national study among Icelandic adolescents. Scand J Public Health. 2008;36:361–8.CrossRef Sigfusdottir ID, Asgeirsdottir BB, Sigurdsson JF, Gudjonsson GH. Trends in depressive symptoms, anxiety symptoms and visits to healthcare specialists: a national study among Icelandic adolescents. Scand J Public Health. 2008;36:361–8.CrossRef
7.
go back to reference Smith RP, Larkin GL, Southwick SM. Trends in U.S. emergency department visits for anxiety-related mental health conditions, 1992-2001. J Clin Psychiatry. 2008;69:286–94.CrossRef Smith RP, Larkin GL, Southwick SM. Trends in U.S. emergency department visits for anxiety-related mental health conditions, 1992-2001. J Clin Psychiatry. 2008;69:286–94.CrossRef
8.
go back to reference Ma J, Lee KV, Stafford RS. Depression treatment during outpatient visits by U.S. children and adolescents. J Adolesc Health. 2005;37:434–42.CrossRef Ma J, Lee KV, Stafford RS. Depression treatment during outpatient visits by U.S. children and adolescents. J Adolesc Health. 2005;37:434–42.CrossRef
9.
go back to reference Blader JC. Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry. 2011;68:1276–83.CrossRef Blader JC. Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry. 2011;68:1276–83.CrossRef
10.
go back to reference Baxter AJ, Scott KM, Ferrari AJ, Norman RE, Vos T, Whiteford HA. Challenging the myth of an "epidemic" of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety. 2014;31:506–16.CrossRef Baxter AJ, Scott KM, Ferrari AJ, Norman RE, Vos T, Whiteford HA. Challenging the myth of an "epidemic" of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety. 2014;31:506–16.CrossRef
11.
go back to reference de Graaf R, ten Have M, van Gool C, van Dorsselaer S. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands mental health survey and incidence Study-2. Soc Psychiatry Psychiatr Epidemiol. 2012;47:203–13.CrossRef de Graaf R, ten Have M, van Gool C, van Dorsselaer S. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands mental health survey and incidence Study-2. Soc Psychiatry Psychiatr Epidemiol. 2012;47:203–13.CrossRef
12.
go back to reference Collishaw S. Annual research review: secular trends in child and adolescent mental health. J Child Psychol Psychiatry. 2015;56:370–93.CrossRef Collishaw S. Annual research review: secular trends in child and adolescent mental health. J Child Psychol Psychiatry. 2015;56:370–93.CrossRef
13.
go back to reference Collishaw S, Maughan B, Natarajan L, Pickles A. Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart. J Child Psychol Psychiatry. 2010;51:885–94.CrossRef Collishaw S, Maughan B, Natarajan L, Pickles A. Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart. J Child Psychol Psychiatry. 2010;51:885–94.CrossRef
14.
go back to reference McManus S, Bebbington P, Jenkins R, Brugha T, editors. Mental health and wellbeing in England: adult psychiatric morbidity survey 2014. Leeds: NHS Digital; 2016. McManus S, Bebbington P, Jenkins R, Brugha T, editors. Mental health and wellbeing in England: adult psychiatric morbidity survey 2014. Leeds: NHS Digital; 2016.
15.
go back to reference Fichter MM, Xepapadakos F, Quadflieg N, Georgopoulou E, Fthenakis WEA. Comparative study of psychopathology in Greek adolescents in Germany and in Greece in 1980 and 1998–18 years apart. Eur Arch Psychiatry Clin Neurosci. 2004;254:27–35.CrossRef Fichter MM, Xepapadakos F, Quadflieg N, Georgopoulou E, Fthenakis WEA. Comparative study of psychopathology in Greek adolescents in Germany and in Greece in 1980 and 1998–18 years apart. Eur Arch Psychiatry Clin Neurosci. 2004;254:27–35.CrossRef
16.
go back to reference Sweeting H, Young R, West P. GHQ increases among Scottish 15 year olds 1987-2006. Soc Psychiatry Psychiatr Epidemiol. 2009;44:579–86.CrossRef Sweeting H, Young R, West P. GHQ increases among Scottish 15 year olds 1987-2006. Soc Psychiatry Psychiatr Epidemiol. 2009;44:579–86.CrossRef
17.
go back to reference The PLOS Medicine Editors. The paradox of mental health: over-treatment and under-recognition. PLoS Med. 2013;10:e1001456.CrossRef The PLOS Medicine Editors. The paradox of mental health: over-treatment and under-recognition. PLoS Med. 2013;10:e1001456.CrossRef
18.
go back to reference Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust. 2007;187:35–9.CrossRef Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust. 2007;187:35–9.CrossRef
19.
go back to reference Bonabi H, Müller M, Ajdacic-Gross V, Eisele J, Rodgers S, Seifritz E, Rössler W, Rüsch N. Mental health literacy, attitudes to help seeking, and perceived need as predictors of mental health service use: a longitudinal study. J Nerv Ment Dis. 2016;204:321–4.CrossRef Bonabi H, Müller M, Ajdacic-Gross V, Eisele J, Rodgers S, Seifritz E, Rössler W, Rüsch N. Mental health literacy, attitudes to help seeking, and perceived need as predictors of mental health service use: a longitudinal study. J Nerv Ment Dis. 2016;204:321–4.CrossRef
20.
go back to reference Meadows GN, Burgess PM. Perceived need for mental health care: findings from the 2007 Australian survey of mental health and wellbeing. Aust N Z J Psychiatry. 2009;43:624–34.CrossRef Meadows GN, Burgess PM. Perceived need for mental health care: findings from the 2007 Australian survey of mental health and wellbeing. Aust N Z J Psychiatry. 2009;43:624–34.CrossRef
21.
go back to reference Kosidou K, Lundin A, Lewis G, Fredlund P, Dal H, Dalman C. Trends in levels of self-reported psychological distress among individuals who seek psychiatric services over eight years: a comparison between age groups in three population surveys in Stockholm region. BMC Psychiatry. 2017;17:345.CrossRef Kosidou K, Lundin A, Lewis G, Fredlund P, Dal H, Dalman C. Trends in levels of self-reported psychological distress among individuals who seek psychiatric services over eight years: a comparison between age groups in three population surveys in Stockholm region. BMC Psychiatry. 2017;17:345.CrossRef
22.
go back to reference MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, Williams B, Crombie I. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326:1014.CrossRef MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, Williams B, Crombie I. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326:1014.CrossRef
23.
go back to reference Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47–53.CrossRef Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47–53.CrossRef
24.
go back to reference Furukawa TA, Weitz ES, Tanaka S, Hollon SD, Hofmann SG, Andersson G, Twisk J, DeRubeis RJ, Dimidjian S, Hegerl U, Mergl R, Jarrett RB, Vittengl JR, Watanabe N, Cuijpers P. Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. Br J Psychiatry. 2017;210:190–6.CrossRef Furukawa TA, Weitz ES, Tanaka S, Hollon SD, Hofmann SG, Andersson G, Twisk J, DeRubeis RJ, Dimidjian S, Hegerl U, Mergl R, Jarrett RB, Vittengl JR, Watanabe N, Cuijpers P. Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. Br J Psychiatry. 2017;210:190–6.CrossRef
25.
go back to reference Twomey C, O'Reilly G, Byrne M. Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract. 2015;32:3–15.CrossRef Twomey C, O'Reilly G, Byrne M. Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract. 2015;32:3–15.CrossRef
26.
go back to reference Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet. 2005;366:237–48.CrossRef Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet. 2005;366:237–48.CrossRef
27.
go back to reference Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017;16:90–9.CrossRef Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017;16:90–9.CrossRef
28.
go back to reference Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundström A, Westerholm B, Rosén M. The new Swedish prescribed drug register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007;16:726–35.CrossRef Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundström A, Westerholm B, Rosén M. The new Swedish prescribed drug register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007;16:726–35.CrossRef
29.
go back to reference Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRef Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRef
30.
go back to reference Åsbring N, Dal H, Ohrling M, Dalman C (2014) Var femte som besökte vårdcentral fick hjälp mot psykisk ohälsa. Läkartidningen 111:CZCP. Åsbring N, Dal H, Ohrling M, Dalman C (2014) Var femte som besökte vårdcentral fick hjälp mot psykisk ohälsa. Läkartidningen 111:CZCP.
31.
go back to reference Patten SB, Williams JV, Lavorato DH, Wang JL, McDonald K, Bulloch AG. Descriptive epidemiology of major depressive disorder in Canada in 2012. Can J Psychiatr. 2015;60:23–30.CrossRef Patten SB, Williams JV, Lavorato DH, Wang JL, McDonald K, Bulloch AG. Descriptive epidemiology of major depressive disorder in Canada in 2012. Can J Psychiatr. 2015;60:23–30.CrossRef
32.
go back to reference Mojtabai R, Jorm AF. Trends in psychological distress, depressive episodes and mental health treatment-seeking in the United States: 2001-2012. J Affect Disord. 2015;174:556–61.CrossRef Mojtabai R, Jorm AF. Trends in psychological distress, depressive episodes and mental health treatment-seeking in the United States: 2001-2012. J Affect Disord. 2015;174:556–61.CrossRef
33.
go back to reference Johansson R, Carlbring P, Heedman Å, Paxling B, Andersson G. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. PeerJ. 2013;1:e98.CrossRef Johansson R, Carlbring P, Heedman Å, Paxling B, Andersson G. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. PeerJ. 2013;1:e98.CrossRef
Metadata
Title
Trends in psychiatric diagnoses, medications and psychological therapies in a large Swedish region: a population-based study
Authors
T. Forslund
K. Kosidou
S. Wicks
C. Dalman
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02749-z

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