Psychological Medicine

Original Articles

Common mental disorder diagnosis and need for treatment are not the same: findings from a population-based longitudinal survey

J. Sareena1 c1, C. A. Henriksena2, M. B. Steina3, T. O. Afifia4, L. M. Lixa5 and M. W. Ennsa1

a1 Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

a2 Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, MB, Canada

a3 Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA

a4 Departments of Community Health Sciences, Psychiatry, and Family Social Sciences, University of Manitoba, Winnipeg, MB, Canada

a5 School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada


Background Controversy exists regarding whether people in the community who meet criteria for a non-psychotic mental disorder diagnosis are necessarily in need of treatment. Some have argued that these individuals require treatment and that policy makers need to develop outreach programs for them, whereas others have argued that the current epidemiologic studies may be diagnosing symptoms of distress that in many cases are self-limiting and likely to remit without treatment. All prior studies that have addressed this issue have been cross-sectional. We examined the longitudinal outcomes of individuals with depressive, anxiety and substance use (DAS) disorder(s) who had not previously received any treatment.

Method Data came from a nationally representative US sample. A total of 34 653 non-institutionalized adults (age ≥20 years) were interviewed at two time points, 3 years apart. DAS disorders, mental health service use and quality of life (QoL) were assessed at both time points.

Results Individuals with a DAS disorder who had not previously received any treatment were significantly more likely than those who had been previously treated to have remission of their index disorder(s) without subsequent treatment, to be free of co-morbid disorder(s) and not to have attempted suicide during the 3-year follow-up period (50.7% v. 33.0% respectively, p < 0.05). At wave 2, multiple linear regression demonstrated that people with a remission of their baseline DAS disorder(s) had levels of functioning similar to those without a DAS disorder.

Conclusions Individuals with an untreated DAS disorder at baseline have a substantial likelihood of remission without any subsequent intervention.

(Received August 08 2012)

(Revised November 02 2012)

(Accepted November 13 2012)

(Online publication December 07 2012)

Key words

  • Anxiety;
  • depression;
  • mental health service use;
  • need for treatment;
  • substance use


c1 Address for correspondence: J. Sareen, M.D., PZ430-771 Bannatyne Avenue, Winnipeg, MB, Canada R3E 3N4. (Email: