Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative.

Journal: Psychological medicine

Volume: 51

Issue: 12

Year of Publication: 2022

Affiliated Institutions:  Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA. College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, 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. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA. IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy. Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands. National School of Public Health, Management and Development, Bucharest, Romania. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. National Center of Public Health and Analyses, Sofia, Bulgaria. Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon. Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan. Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland. Ecole des Hautes Etudes en Santé Publique (EHESP), EA , Paris Descartes University, Paris, France. 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. School of Psychology, Ulster University, Londonderry, United Kingdom. Universidad Cayetano Heredia, Lima, Peru. Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia. Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal and. Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel.

Abstract summary 

There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.Respondents from 13 low- or middle-income countries ( = 60 224) and 15 in high-income countries ( = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

Authors & Co-authors:  Fernández Daniel D Vigo Daniel D Sampson Nancy A NA Hwang Irving I Aguilar-Gaxiola Sergio S Al-Hamzawi Ali O AO Alonso Jordi J Andrade Laura Helena LH Bromet Evelyn J EJ de Girolamo Giovanni G de Jonge Peter P Florescu Silvia S Gureje Oye O Hinkov Hristo H Hu Chiyi C Karam Elie G EG Karam Georges G Kawakami Norito N Kiejna Andrzej A Kovess-Masfety Viviane V Medina-Mora Maria E ME Navarro-Mateu Fernando F Ojagbemi Akin A O'Neill Siobhan S Piazza Marina M Posada-Villa Jose J Rapsey Charlene C Williams David R DR Xavier Miguel M Ziv Yuval Y Kessler Ronald C RC Haro Josep M JM

Study Outcome 

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Statistics
Citations :  Agarwal P, Pan X, & Sambamoorthi U (2013). Depression treatment patterns among individuals with osteoarthritis : A cross sectional study. BMC Psychiatry, 13, 121. doi: 10.1186/1471-244X-13-121
Authors :  32
Identifiers
Doi : 10.1017/S0033291720000884
SSN : 1469-8978
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
Dropout;WMH surveys;mental health;survival analysis
Study Design
Cross Sectional Study
Study Approach
Country of Study
Publication Country
England