Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
Journal: Psychological medicine
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Affiliated Institutions:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
National School of Public Health, Management and Development, Bucharest, Romania.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, 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.
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain.
Department of Psychiatry, University of Ibadan, Nigeria.
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia.
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil.
Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan.
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Abstract summary
Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks.Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both.MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination.Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
Authors & Co-authors:
Vigo Daniel D
Haro Josep Maria JM
Hwang Irving I
Aguilar-Gaxiola Sergio S
Alonso Jordi J
Borges Guilherme G
Bruffaerts Ronny R
Caldas-de-Almeida Jose Miguel JM
de Girolamo Giovanni G
Florescu Silvia S
Gureje Oye O
Karam Elie E
Karam Georges G
Kovess-Masfety Viviane V
Lee Sing S
Navarro-Mateu Fernando F
Ojagbemi Akin A
Posada-Villa Jose J
Sampson Nancy A NA
Scott Kate K
Stagnaro Juan Carlos JC
Ten Have Margreet M
Viana Maria Carmen MC
Wu Chi-Shin CS
Chatterji Somnath S
Cuijpers Pim P
Thornicroft Graham G
Kessler Ronald C RC
Study Outcome
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