PSYCHIATRIC-DISORDER ONSET AND FIRST TREATMENT CONTACT IN THE UNITED-STATES AND ONTARIO

Objective: The authors describe the timing of the first treatment cont act following new-onset DSM-III-R mood, anxiety, and addictive disorde rs in community samples from the United States and Ontario, Canada, be fore and after passage of the Ontario Health Insurance Plan. Method: T he authors drew data from the National Comorbidity Survey (NCS) (N=8,0 98) and the mental health supplement to the Ontario Health Survey (OHS ) (N=9,953). They assessed psychiatric disorders with a modified versi on of the Composite International Diagnostic Interview; they also asse ssed retrospectively age at disorder onset and first treatment contact . They used the Kaplan-Meier method to generate time-to-treatment curv es and survival analysis to compare time-to-treatment intervals across the two surveys. Results: The overall time-to-treatment curves reveal ed substantial differences between disorders that were consistent acro ss the two surveys. In both surveys, panic disorder had the highest pr obability of first-year treatment (NCS, 65.6%; OHS supplement, 52.6%), while phobia (NCS, 12.0%; OHS supplement: 6.5%) and addictive disorde rs (NCS, 6.4%; OHS supplement, 4.2%) had the lowest in both surveys. R etrospective subgroup analysis suggests that before the passage of the Ontario public insurance plan, the likelihood of receiving treatment in the year of disorder onset was greater in Ontario than in the Unite d States but that this relationship reversed following passage of the Ontario plan. During this period, the authors observed no significant between-country differences in the probability of prompt treatment of adults with 12 or fewer years of education. Conclusions: These results challenge the assumption that the universal health insurance plan in Ontario promotes greater access to mental health services than is avai lable in the United States for vulnerable groups. Marked differences b etween disorders in the speed to first treatment suggest that in both countries, clinical factors play an important role in the timing of th e initial decision to seek treatment.