Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys.
Journal: BMC psychiatry
Volume: 23
Issue: 1
Year of Publication: 2023
Affiliated Institutions:
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. dan.stein@uct.ac.za.
Department of Psychology, Yale University, New Haven, CT, USA.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
School of Public Health, The University of Queensland, Herston, Queensland, Australia.
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, CIBER en Epidemiología y Salud Pública (CIBERESP), Pompeu Fabra University (UPF), Barcelona, Spain.
Núcleo de Epidemiologia Psiquiátrica - LIM , Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
Lisbon Institute of Global Mental Health, Comprehensive Health Research Center (CHRC)/NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
National School of Public Health, Management and Professional Development, Bucharest, Romania.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
Ecole des Hautes Etudes en Santé Publique (EHESP), EA , Paris Descartes University, Paris, France.
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain.
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
Abstract summary
Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.
Authors & Co-authors:
Stein Dan J DJ
Kazdin Alan E AE
Munthali Richard J RJ
Hwang Irving I
Harris Meredith G MG
Alonso Jordi J
Andrade Laura Helena LH
Bruffaerts Ronny R
Cardoso Graça G
Chardoul Stephanie S
de Girolamo Giovanni G
Florescu Silvia S
Gureje Oye O
Haro Josep Maria JM
Karam Aimee N AN
Karam Elie G EG
Kovess-Masfety Viviane V
Lee Sing S
Medina-Mora Maria Elena ME
Navarro-Mateu Fernando F
Posada-Villa José J
Stagnaro Juan Carlos JC
Ten Have Margreet M
Sampson Nancy A NA
Kessler Ronald C RC
Vigo Daniel V DV
Study Outcome
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