مقایسه اجتماعی پریشانی و کمک طلبی سلامت روان در کل جمعیت آمریکا

Abstract The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio = 1.84) or to perceive an unmet need for such help (adjusted odds ratio = 1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need—as measured by non-compared distress—and help-seeking in the general population.

Results Of 36,679 participants who responded to questions about compared distress, 8444 (20.3%) described themselves as more worried, nervous or anxious than others and 28,235 (79.7%) as no more worried, nervous or anxious than others. All socio-demographic and clinical variables included in the bivariate analyses for correlates of socially compared distress were significantly associated with compared distress on the one hand and with help-seeking and perceived unmet need for care, on the other hand. The results of these analyses for the correlates of socially compared distress are presented in Table 1. These analyses showed that compared to adults in the 18–25 years age range, adults over age 35 years were less likely to describe themselves as more distressed than others, as were males compared to females, non-Hispanic blacks compared to whites, the more educated compared to the less educated and the retired adults compared the working adults (Table 1). Whereas, divorced, separated or never married adults were more likely than the currently married to identify themselves as more distressed than others, as were the unemployed or disabled compared to the working, those with less than $20,000 family income compared to those with incomes equal or more than $20,000, and those who rated their general health status as poorer than “excellent” compared with those who rated their health as “excellent” (Table 1). As expected, participants with more distress (measured by K10), more impairment in functioning due to mental health problems (measured by the modified WHO-DAS), longer duration of impairment and substance disorders (except for non-alcohol drug abuse) were more likely to identify themselves as more worried, nervous or anxious compared to others (Table 1). Table 1. Bivariate binary logistic regression analyses of the correlates of socially compared distress Variable More worried, nervous or anxious No more worried nervous or anxious OR 99% CI p N Row %a N Row%a Age, years 18–25 4460 24.0 13,766 76.0 ref. – – 26–34 1390 25.5 4116 74.5 1.08 0.96–1.22 0.088 35–49 1810 21.4 6207 78.6 0.86 0.77–0.96 0.001 ≥50 784 15.8 4146 84.2 0.59 0.52–0.68 <0.001 Overall test b F = 35.81, df = 3, 898, p < 0.001 Gender Female 5244 23.3 14,249 76.7 ref. – – Male 3200 17.0 13,986 83.0 0.67 0.60–0.75 <0.001 Race/ethnicity Caucasian white 5969 20.8 18,936 79.2 ref. – – Non-Hispanic black 776 15.9 3493 84.1 0.72 0.59–0.88 <0.001 Hispanic 1130 22.0 3864 78.0 1.07 0.91–1.26 0.275 Other 569 19.2 1942 80.8 0.90 0.70–1.16 0.292 Overall test b F = 7.59, df = 3, 898, p < 0.001 Marital status Married 3012 18.4 11,430 81.6 ref. – – Widowed 127 14.3 726 85.7 0.74 0.52–1.04 0.025 Divorced/separated 883 23.2 2489 76.8 1.34 1.14–1.57 <0.001 Never married 4422 24.8 13,590 75.2 1.46 1.31–1.63 <0.001 Overall test b F = 32.12, df = 3, 898, p < 0.001 Education, years <12 1727 23.5 5215 76.5 ref. – – 12 2767 20.5 9659 79.5 0.84 0.71–0.99 0.006 >12 3950 19.1 13,361 80.9 0.77 0.66–0.90 <0.001 Overall test b F = 9.94, df = 2, 899, p < 0.001 Employment status Working/home maker/student 6995 20.3 23,882 79.7 ref. – – Unemployed 782 26.3 2274 73.7 1.41 1.15–1.72 <0.001 Disabled 427 36.5 560 63.5 2.26 1.74–2.93 <0.001 Retired 237 13.3 1506 86.7 0.61 0.47–0.77 <0.001 Overall test b F = 41.60, df = 3, 898, p < 0.001 Annual family income, $ ≥20,000 5866 19.1 21,137 80.9 ref. – – <20,000 2578 25.4 7098 74.6 1.44 1.28–1.63 <0.001 Health status Excellent 1860 16.1 8484 83.9 ref. – – Very good 3150 19.1 10,958 80.9 1.23 1.06–1.43 <0.001 Good 2370 22.4 6764 77.6 1.50 1.28–1.77 <0.001 Fair 846 26.1 1740 73.9 1.84 1.50–2.26 <0.001 Poor 212 35.9 283 64.1 2.92 2.05–4.16 <0.001 Overall test b F = 27.22, df = 4, 897, p < 0.001 Duration of impairment in weeksc 0 3664 12.9 22,372 87.1 ref. – – 1–4 2151 34.6 3872 65.4 3.56 3.06–4.13 <0.001 5–8 795 48.0 808 52.0 6.22 4.99–7.77 <0.001 9–26 1138 60.4 689 39.6 10.26 8.30–12.69 <0.001 ≥27 603 77.8 166 22.2 23.55 15.20–36.49 <0.001 Overall test b F = 369.46, df = 4, 897, p < 0.001 Substance disorders, 12-month None 6625 18.9 24,576 81.1 ref. – – Alcohol dependence 757 41.4 1129 58.6 2.63 2.10–3.30 <0.001 Alcohol abuse 711 26.4 1957 73.6 1.39 1.13–1.70 <0.001 Non-alcohol drug dependence 511 45.1 713 54.9 2.57 1.96–3.37 <0.001 Non-alcohol drug abuse 189 28.6 420 71.4 1.23 0.83–1.81 0.17 Overall test b F = 62.25, df = 4, 897, p < 0.001 Mean SE Mean SE K10 score 14.81 0.17 5.80 0.06 1.14 1.13–1.15 <0.001 WHO-DAS score 8.99 0.16 2.83 0.05 1.11 1.11–1.12 <0.001 Note: OR stands for odds ratio; CI stands for confidence interval. a Percentages are weighted by sampling weights. b Adjusted Wald test. c As ascertained by WHO-DAS. Table options Socially compared distress was significantly associated with mental health help-seeking and perceived unmet need for mental health care. In bivariate analyses, of those participants who perceived themselves as more worried, nervous or anxious than others, 31.7% sought mental health help, compared to 8.4% of those who did not perceive themselves so (OR = 5.04, 99% CI = 4.36–5.83, t = 28.88, df = 900, p < 0.001). Similarly, among participants who did not seek any mental health professional help in the past year, 9.2% of those who perceived themselves as more worried, anxious or nervous than others reported that they needed mental health care but did not receive such care, compared to 1.7% of those who did not perceive themselves as more worried, nervous or anxious than others (OR = 5.80, 99% CI = 4.50–7.47, t = 17.89, df = 900, p < 0.001). The association of socially compared distress with mental health treatment seeking and perceived unmet need for mental health care persisted in multivariate analyses adjusting for potentially confounding factors ( Table 2). However, the magnitude of the odds ratios was meaningfully reduced in multivariate analyses, suggesting that the variables included in the multivariate models were significant confounders of the relationship between socially compared distress on the one hand and help-seeking and perceived unmet need on the other hand. Table 2. Multivariate binary logistic regression analyses for the association of socially compared distress with mental health help-seeking and perceived unmet need for mental health care adjusting for potentially confounding socio-demographic and clinical variables Variable Mental health help-seeking Perceived unmet need AOR 99% CI p AOR 99% CI p Compared distress No more worried, nervous or anxious ref. – – ref. – – More worried, nervous or anxious 1.84 1.53–2.22 <0.001 1.44 1.06–1.97 0.003 Age, years 18–25 ref. – – ref. – – 26–34 1.30 1.05–1.59 0.001 0.99 0.70–1.39 0.933 35–49 1.53 1.22–1.90 <0.001 1.03 0.71–1.48 0.858 ≥50 1.58 1.18–2.10 <0.001 0.54 0.29–1.03 0.014 Overall test a F = 8.99, df = 3, 898, p < 0.001 F = 2.72, df = 3, 898, p = 0.043 Gender Female ref. – – ref. – – Male 0.49 0.41–0.57 <0.001 0.44 0.33–0.59 <0.001 Race/ethnicity Caucasian white ref. – – ref. – – Non-Hispanic black 0.56 0.41–0.76 <0.001 0.75 0.44–1.30 0.179 Hispanic 0.56 0.43–0.74 <0.001 0.94 0.61–1.44 0.688 Other 0.42 0.27–0.64 <0.001 0.44 0.24–0.82 0.001 Overall test a F = 21.69, df = 3, 898, p < 0.001 F = 430, df = 3, 898, p = 0.005 Marital status Married ref. – – ref. – – Widowed 0.83 0.52–1.31 0.282 0.26 0.06–1.19 0.023 Divorced/separated 1.28 1.03–1.59 0.004 1.28 0.79–2.06 0.184 Never married 0.98 0.78–1.23 0.794 1.22 0.86–1.73 0.150 Overall test a F = 3.71, df = 3, 898, p < 0.001 F = 2.98, df = 3, 898, p = 0.031 Education, years <12 ref. – – ref. – – 12 1.32 1.00–1.75 0.010 1.43 0.96–2.11 0.019 >12 1.80 1.38–2.35 <0.001 2.37 1.64–3.43 <0.001 Overall test a F = 20.62, df = 2, 899, p < 0.001 F = 21.36, df = 2, 899, p < 0.001 Employment status Working/home maker/student ref. – – ref. – – Unemployed 1.08 0.78–1.49 0.529 1.20 0.77–1.87 0.293 Disabled 2.59 1.77–3.79 <0.001 2.28 0.84–6.14 0.032 Retired 0.87 0.61–1.24 0.305 0.43 0.08–2.22 0.183 Overall test a F = 17.09, df = 3, 898, p < 0.001 F = 2.88, df = 3, 898, p = 0.035 Annual family income, $ ≥20,000 ref. – – ref. – – <20,000 0.98 0.80–1.22 0.850 0.74 0.534–1.02 0.016 Health status Excellent ref. – – ref. – – Very good 1.01 0.84–1.21 0.901 1.32 0.91–1.90 0.053 Good 1.23 0.99–1.54 0.016 1.25 0.84–1.85 0.141 Fair 1.47 1.08–2.00 0.001 1.09 0.59–2.02 0.713 Poor 2.23 1.16–4.30 0.002 0.83 0.23–3.05 0.714 Overall test a F = 5.42, df = 4, 897, p < 0.001 F = 1.17, df = 4, 897, p = 0.321 Duration of impairment in weeksb 0 ref. – – ref. – – 1–4 1.54 1.22–1.96 <0.001 2.16 1.43–3.26 <0.001 5–8 2.15 1.52–3.02 <0.001 2.94 1.78–4.86 <0.001 9–26 2.24 1.64–3.06 <0.001 3.18 1.89–5.33 <0.001 ≥27 3.43 2.18–5.37 <0.001 4.49 2.07–9.74 <0.001 Overall test a F = 20.63, df = 4, 897, p < 0.001 F = 11.34, df = 4, 897, p < 0.001 Substance disorders, 12-month None ref. – – ref. – – Alcohol dependence 1.06 0.76–1.47 0.675 1.83 1.13–2.97 0.001 Alcohol abuse 1.08 0.79–1.47 0.533 1.63 1.11–2.39 0.001 Non-alcohol drug dependence 1.53 1.09–2.13 0.001 1.79 1.01–3.18 0.009 Non-alcohol drug abuse 1.36 0.84–2.19 0.100 3.04 1.43–6.46 <0.001 Overall test a F = 3.73, df = 4, 897, p = 0.005 F = 13.73, df = 4, 897, p < 0.001 K10 score 1.07 1.05–1.08 <0.001 1.10 1.08–1.12 <0.001 WHO-DAS score 1.03 1.02–1.05 <0.001 1.04 1.02–1.06 <0.001 Insurance status No insurance ref. – – ref. – – Any insurance 1.58 1.24–2.01 <0.001 0.66 0.49–0.89 <0.001 Note: AOR stands for adjusted odds ratio; CI stands for confidence interval. a Adjusted Wald test. b As ascertained by WHO-DAS. Table options The association of compared distress with help-seeking and perceived unmet need at different levels of non-compared distress (as measured by K10) was also examined and graphically presented in Fig. 1 (A and B). Across the range of non-compared distress as measured by K10, participants who identified themselves as more worried, nervous or anxious were significantly (p < 0.01) more likely than those who did not identify themselves as more worried, nervous or anxious than others to seek professional help ( Fig. 1-A) and to perceive unmet need for mental health care ( Fig. 1-B). Comparison of mental health help-seeking (A) and perceived unmet need for mental ... Fig. 1. Comparison of mental health help-seeking (A) and perceived unmet need for mental health care (B) among individuals who identified themselves as more worried, nervous or anxious than others vs. those who identified themselves as no more worried, nervous or anxious than others across the range of non-compared distress (measured by K10). Analyses for perceived unmet need were limited to participants who reported not receiving any mental health care over the past year. The numbers over bars indicate the total number of participants in each category (denominator) and the number who sought professional help or perceived a need for it (numerator). All comparisons were statistically significant at p < 0.01.