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The need for psychiatric treatment in the general population: the Camberwell Needs for Care survey
Open accessAbstract
BACKGROUND: This paper presents the first results of a two-stage psychiatric population survey, which uses a new method of directly evaluating needs for specific psychiatric treatment and the extent to which they have been met. METHOD: The sample was drawn at random from the population of an area of inner south London with high levels of deprivation. Seven hundred and sixty subjects aged 18-65 completed the GHQ-28. All those scoring > 5 and half of the rest were invited to take part in the second stage, comprising measures of mental state (SCAN), social role performance (SRPS), life events and difficulties (LEDS) and a Treatment Inventory. This information was used to rate the community version of the Needs for Care Assessment (NFCAS-C). RESULTS: In all, 408 subjects were interviewed in the second stage. The weighted 1 month prevalence of hierarchically ordered ICD-10 psychiatric disorders was 9.8%, the 1 year prevalence 12.3%. The equivalent prevalences for depressive episode were 3.1% and 5.3% respectively, while those for anxiety states were both 2.8%. At interview nearly 10% of the population were identified as having a need for the treatment of a psychiatric condition. This rose to 10.4% if the whole of the preceding year was assessed. Less than half of all potentially meetable needs were met. There was only partial overlap between diagnosis and an adjudged need for treatment. CONCLUSION: A majority of people with mental health problems do not have proper treatment; given more resources and greater public and medical awareness, most could be treated by family doctors.
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“Although many people are in need of (psychiatric) treatment, few actually receive that treatment, especially where anxiety and depressive disorders are concerned”
From Health beliefs and perceived need for mental health care of anxiety and depression-The patients' perspective explored (2008) · cites this paper as Bebbington, Marsden, & Brewin, 1997
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“2–2% of the general population in any given month (Bebbington et al., 1997; Hunter et al., 2004).”
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“Although the mental disorders and PNCQ variables were assessed based on highly reliable standardized diagnostic interviews conducted by trained personnel, the validity of these diagnoses and the PNCQ may not match that of diagnoses made by trained clinicians.(64) The crosssectional design of the survey precludes any c…”
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“Although use of screening and diagnostic interviews would have yielded more valid estimates of mental health problems [ 30 ], this would have seriously intervened the confidentiality of the present study.”
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“More recently, Bebbington and others (23) and Lehtinen and others (24) have suggested the use of clinicians to individually assess need for treatment on a case-by-case basis in epidemiologically representative samples.”
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“A second study by Bebbington and colleagues [7] which used similar methodology to the first, but with a different semistructured psychiatric interview measure (Schedules for Clinical Assessment in Neuropsychiatry: SCAN [40]), found the prevalence of DP over the past month to be”
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“For the Camberwell study, Bebbington et al (1997) employed essentially the same methods as the current survey.”
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Bebbington, P., Angermeyer, M. C., Azorin, J., Brugha, T. S., Kilian, R., Johnson, S., Toumi, M., & Kornfeld, A. (2005) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0955-5 · Cited by 67
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The assessment of need for mental health services
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“The Camberwell Needs for Care survey suggests that only 28% of the need for treatment of depression, and only 13% relating to anxiety, are met (Bebbington et al. 1997).”
MethodPsychiatric disorder and dysfunction in the UK National Survey of Psychiatric Morbidity
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“In particular, it is not clear how disorders identi®ed in the community relate to the sorts of conditions seen for treatment by primary care physicians and by psychiatrists, and what this would imply about community treatment needs (Bebbington et al. 1997, 1999).”
Self-citationO’Leary, P., & Gould, N. (2008) · The British Journal of Social Work · doi:10.1093/bjsw/bcn130 · Cited by 52
Neurotic disorders and the receipt of psychiatric treatment
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“So far there has been only one direct investigation of needs for specific psychiatric treatment and the extent to which they have been met ( Bebbington et al. 1997, 1999 ).”
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Specialty and sex as predictors of depression in dentists
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“In fact, DP may occur in healthy individuals, often under conditions of stress, fatigue, or drug use (Bebbington et al., 1981; Ross et al., 1991; Bebbington et al., 1997),”
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“A shortened version that provides an account of the views of consumers and carers has since been developed (Marshall et al. 1995), as has a community version for use with primary care and general populations ( Bebbington et al. 1996, 1997; Boardman et al. 2004).”
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Needs for mental health treatment among general practice attenders
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“However, the GHQ-12 questionnaire cannot fully replace the assessment of healthcare need by a clinician, as they also assess how severe, persistent, and treatable symptoms are [70].”
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“Many patients suffering from depression and anxiety disorders cannot be adequately treated within European healthcare systems (1).”
BackgroundEvidence-based treatment for Depersonalisation-derealisation Disorder (DPRD)
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“4% of the general population with a gender ratio of about 1:1, although its comorbidity with depression and anxiety falls between the percentage ranges of 20–40 (Bebbington et al. 1997; Hunter et al. 2004a; Ross 1991).”
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Psychiatrists' Ascertained Treatment Needs for Mental Disorders in a Population-Based Sample
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“%) among BPO employees can be viewed in relation to typical rates found in community samples using the GHQ. Diverse results from community surveys indicate rates of 16.6% in Singapore, [24] 25.7% in the UK [25] -33.7% in Iran.”
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Helping Aged Victims of Crime (the HAVoC Study): Common Crime, Older People and Mental Illness
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The Mind Continues to Matter: Psychologic and Physical Recovery 5 Years After Musculoskeletal Trauma
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“Alternative treatment programmes are presumed to relieve the extensive need for care of these disorders (Bebbington et al. 1997; Andrews et al. 1998) that are becoming a serious medical condition, as is reflected by the likely worldwide burden of these diseases in the coming decades (Murray & Lopez, 1997).”
BackgroundSpecialty and sex as predictors of depression in dentists
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“Some evidence is emerging on the extent of unmet need remaining in the community (Bebbington et al., 1997), particularly for depression.”
BackgroundProjecting mental disorder prevalence from national surveys to populations-of-interest
Messer, S. C., Liu, X., Hoge, C. W., Cowan, D. N., & Engel, C. C. (2004) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-004-0757-1 · Cited by 16
“Future findings from the next wave of “fourth-generation” investigations [ 3 ] (third-generation studies with focus on clinical significance) should provide much needed administrative and policy yields.”
BackgroundA glossary on psychiatric epidemiology
Burger, H., & Neeleman, J. (2007) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2003.019430 · Cited by 16
Adjustment to antidepressant utilization rates to account for depression in remission
Beck, C. A., & Patten, S. B. (2004) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.03.003 · Cited by 15
Störungsepidemiologie: Prävalenz, Behandlungsbedarf und Versorgung von psychischen Störungen
Soeder, U. (2002) · Springer eBooks · doi:10.1007/978-3-642-56025-5_2 · Cited by 14
Paraprofessionals for anxiety and depressive disorders
Boer, P., van den Bosch, R., Neeleman, J., & Wiersma, D. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004688 · Cited by 14
Selection of a Coherent Set of Health Indicators
Jagger, C., & Egidi, V. (2000) · Cited by 13
Recalibration methods to enhance information on prevalence rates from large mental health surveys
Taub, N. A., Morgan, Z., Brugha, T. S., Lambert, P. C., Bebbington, P., Jenkins, R., Kessler, R. C., Zaslavsky, A. M., & Hotz, T. L. (2005) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.13 · Cited by 12
“4%, which is closer to the value that would generally be expected in community populations on SCAN for this group of diagnoses (Bebbington et al., 1997; Brugha et al., 2001), and also close to the estimate obtained from the SCAN data with allowance for the stratification The precision of this latter estimate (Table 4,…”
ResultInfluentialSelf-citationQureshi, N. A., Al-Ghamdy, Y. S., Al-Haddad, N. S., Abdelgadir, M. H., & Tawfik, M. H. (2001) · Saudi Medical Journal · doi:10.15537/1658-3175.1520 · Cited by 12
Brown, J. S. L., Elliott, S. A., & Butler, C. (2006) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465805002663 · Cited by 10
Goldberg, D. (1997) · European Psychiatry · doi:10.1016/s0924-9338(97)80208-8 · Cited by 9
The Classification and Epidemiology of Unipolar Depression
Bebbington, P. (2004) · Wiley eBooks · doi:10.1002/9780470696385.ch1 · Cited by 9
“The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (Wing et al., 1990) are based on a semi-structured interview, and are increasingly used in epidemiological research studies (e.g., Ayuso-Mateos et al., 2001; Bebbington et al., 1997; McConnell et al., 2002; Meltzer et al., 1995).”
Self-citationAttributions and affirmations for overcoming anxiety and depression
Kinnier, R. T., Hofsess, C., Pongratz, R., & Lambert, C. (2009) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1348/147608308x389418 · Cited by 8
Comparison of Three Different Approaches Used in Large-Scale Stress Workshops for the General Public
Main, N., Elliot, S. A., & Brown, J. S. L. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804002012 · Cited by 8
“Given the widespread prevalence of anxiety and depression within the general population, and the considerable degree of unmet need in those who seek help for their problems (Bebbington et al., 1997), the findings from this research have some important implications.”
BackgroundInfluentialSozialpsychiatrie: essentieller Bestandteil der Psychiatrie
Wancata, J., Kapfhammer, H., Schüßler, G., & Fleischhacker, W. W. (2007) · Psychiatrie und Psychotherapie · doi:10.1007/s11326-007-0048-z · Cited by 7
Ting, N. (2014) · Journal of Scientific Research and Reports · doi:10.9734/jsrr/2014/10369 · Cited by 7
“8% of the general population may experience depression at any one time [11-13].”
BackgroundCognitive functions in depression and anxiety disorders : findings from a population-based study
Airaksinen, E. (2006) · Figshare · Cited by 7
Patel, K., Bosqui, T. J., Kouvonen, A. M., Donnelly, M., Väänänen, A., Bell, J., & O’Reilly, D. (2020) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2019-212774 · Cited by 7
“12 In the UK, migrants need to first register for a medical card before they can access health services, 13 which may not be obvious, as there are no induction programmes for migrants.”
Provision and remuneration of psychotherapeutic services in Switzerland
Beeler, I., Lorenz, S., & Szucs, T. D. (2003) · Sozial- und Präventivmedizin · doi:10.1007/s00038-003-1107-x · Cited by 6
“According to different analyses, 12.3–15.6% of the population has demand for some kind and volume of psychotherapeutic treatment (Bebbington et al. 1997; Linden et al. 1996).”
BackgroundInfluentialPsychiatrische Epidemiologie und Bevölkerungsmedizin
Baune, B. T., & Arolt, V. (2005) · Der Nervenarzt · doi:10.1007/s00115-005-1922-9 · Cited by 6
Managing depression in primary care: it's not only what you do it's the way that you do it
Boardman, J., & Walters, P. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x395049 · Cited by 6
Psychological Distress and Physical Vulnerability
Bertelli, M. O., Fletcher, R., Weber, G., Schuengel, C., Scuticchio, D., Bianco, A., Rondini, E., Perera, B., & Courtenay, K. (2022) · Springer eBooks · doi:10.1007/978-3-319-95720-3_3 · Cited by 5
Carraturo, F., Santonicola, R., & Cella, S. (2025) · Clinical psychological science : a journal of the Association for Psychological Science · doi:10.1177/21677026251365927 · Cited by 4
“The reports included in the qualitative synthesis from secondary studies references were Shirzadi et al. (2019), retrieved from Seddigh (2021); Bebbington et al. (1981, 1997), retrieved from Hunter et al. (2004); and Sethi et al. (1972, 1974), retrieved from Ganguli (2000).”
Fleury, M., Bamvita, J., Grenier, G., & Caron, J. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph121013016 · Cited by 5
“The proportion of individuals who said they had not received any help for their expressed needs (N = 104, 18%) or had received only partial help (N = 374, 65%) confirms that most perceived needs are not fully met, as found previously in most studies related to this subject [10,24,58–61].”
ResultDixon, C., Mansell, W., Rawlinson, E., & Gibson, A. (2011) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x10000176 · Cited by 4
“The Camberwell Needs for Care Survey concluded that only 28% of the need for depression treatment and only 13% of the need for anxiety treatment is ever met (Bebbington et al. 1997).”
MethodLasalvia, A., Stefani, B., & Ruggeri, M. (2000) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00007879 · Cited by 4
Needs for care in psychiatric patients: a systematic review II. Needs for care on individual level
Lasalvia, A., Stefani, B., & Ruggeri, M. (2000) · Epidemiology and Psychiatric Sciences · doi:10.1017/s1121189x00008411 · Cited by 3
Assessment of Distress, Disorder, Impairment, and Need in the Population
Eaton, W. W., Mojtabai, R., Stuart, E. A., Leoutsakos, J., & Kuramoto, S. J. (2012) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195390445.003.0004 · Cited by 3
Sampling and weighting of the Austrian Psychiatric Prevalence Survey (APPS)
Alexandrowicz, R. W., Bacher, J., & Wancata, J. (2019) · Neuropsychiatrie · doi:10.1007/s40211-019-0305-6 · Cited by 3
Diagnosing Depression in Primary Care: Lessons from Developing Guidelines
Bosch, M. (2000) · Mental Health Review Journal · doi:10.1108/13619322200000034 · Cited by 3
Socioeconomic Burden of Mental Disorders in Spain 2006-2017Preprint
Stoyanova, A., & Pinilla, J. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3369466 · Cited by 3
Tinning, L., Harman, K., Lee, R., & Brown, J. S. L. (2009) · Journal of Public Mental Health · doi:10.1108/17465729200900011 · Cited by 2
Evaluating quality of mental health care
Westrin, C. (1999) · Current Opinion in Psychiatry · doi:10.1097/00001504-199903000-00011 · Cited by 2
Metadata
- Authors
- BEBBINGTON, P. E., MARSDEN, L., & BREWIN, C. R.
- Affiliations
- University College London (GB)
- Royal Holloway University of London (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 1997-07
- Volume
- 27
- Issue
- 4
- Pages
- 821-834
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2136934645
- Cited by
- 117
- References
- 21
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2020: 4 · 2019: 4 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 12.07
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Medical Studies
- Keywords
- unmet treatment needs, mental health prevalence, GHQ-28, social role performance, depressive episodes, anxiety disorders, primary care mental health services, social deprivation, inner London
- MeSH terms
- Adolescent, Adult, Aged, Anxiety, Mental Disorders, Cross-Sectional Studies, Depression, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, London, Male, Mental Health Services, Middle Aged, Sampling Studies, Urban Health, Prevalence, Episode of Care, Health Care Surveys
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