Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys.
Journal: Psychological medicine
Volume: 48
Issue: 9
Year of Publication: 2019
Affiliated Institutions:
Kings College London, Institute of Psychiatry, Psychology & Neuroscience,De Crespigny Park, London SE AF,UK.
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.
Department of Epidemiologic and Psychosocial Research,National Institute of Psychiatry Ramón de la Fuente Muniz,Mexico City,Mexico.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg,Leuven,Belgium.
Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
National School of Public Health, Management and Development,Bucharest,Romania.
Unit of Epidemiological and Evaluation Psychiatry,Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre,Via Pilastroni , Brescia,Italy.
Department of Psychiatry,University College Hospital,Ibadan,Nigeria.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat,Barcelona,Spain.
Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine,Shanghai,China.
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital,Shenzhen,China.
Faculty of Medicine,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.
Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong.
Ecole des Hautes Etudes en Santé Publique (EHESP), EA , Paris Descartes University,Paris,France.
Mental Health Services, Ministry of Health,Jerusalem,Israel.
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia,Murcia,Spain.
Survey Research Center, Institute for Social Research, University of Michigan,Ann Arbor, Michigan,USA.
Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand.
National Institute of Mental Health, National Center for Neurology and Psychiatry,Kodaira, Tokyo,Japan.
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction,Utrecht,Netherlands.
Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil.
Department of Society, Human Development, and Health,Harvard T.H. Chan School of Public Health,Boston, Massachusetts,USA.
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene,Warsaw,Poland.
Directorate of Mental Health, National Center of Public Health and Analyses,Sofia,Bulgaria.
Department of Information, Evidence and Research,World Health Organization,Geneva,Switzerland.
Abstract summary
The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
Authors & Co-authors:
Evans-Lacko S S
Aguilar-Gaxiola S S
Al-Hamzawi A A
Alonso J J
Benjet C C
Bruffaerts R R
Chiu W T WT
Florescu S S
de Girolamo G G
Gureje O O
Haro J M JM
He Y Y
Hu C C
Karam E G EG
Kawakami N N
Lee S S
Lund C C
Kovess-Masfety V V
Levinson D D
Navarro-Mateu F F
Pennell B E BE
Sampson N A NA
Scott K M KM
Tachimori H H
Ten Have M M
Viana M C MC
Williams D R DR
Wojtyniak B J BJ
Zarkov Z Z
Kessler R C RC
Chatterji S S
Thornicroft G G
Study Outcome
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