Barriers to 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys.
Journal: International journal of mental health systems
Volume: 19
Issue: 1
Year of Publication:
Affiliated Institutions:
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Av. Marechal Campos, , Vitória, ES, CEP .-, Brazil.
Department of Psychology, Yale University, Hillhouse Avenue, , New Haven, CT, , USA.
School of Public Health, The University of Queensland, C/O QCMHR, Locked Bag , Archerfield, QLD, , Australia.
Department of Psychiatry & Mental Health and South African Medical Council Research Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, , ZA, South Africa.
Department of Psychiatry & School of Population and Public Health, Faculty of Medicine, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room , Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, VT A, Canada.
Department of Health Care Policy, Harvard Medical School, Longwood Avenue, Boston, MA, , USA.
IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, , , Barcelona, Spain.
University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM , Rua Dr. Ovidio Pires de Campos, , São Paulo, CEP -, Brazil.
National Institute of Psychiatry Ramón de La Fuente Muñiz, Calz. Mexico-Xochimilco , San Lorenzo Huipulco, , Ciudad de Mexico, Mexico.
School of Psychology, Ulster University, Coleraine Campus, Coleraine, BT SA, UK.
Lisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua Do Instituto Bacteriológico, , -, Lisbon, Portugal.
IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni , Brescia, Italy.
Department of Developmental Psychology, University of Groningen, Grote Kruisstraat /, TS, Groningen, The Netherlands.
Department of Psychiatry, University of Ibadan, University College Hospital, PMB , Ibadan, Nigeria.
Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, , , Sant Boi de Llobregat, Barcelona, Spain.
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
Institut de Psychologie, UR , Université Paris Cité, avenue Édouard Vaillant, Boulogne Billancourt, , Paris, France.
Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego , -, Warsaw, Poland.
Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/Lorca, no . -El Palmar, , Murcia, Spain.
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, --, Hongo, Bunkyo-Ku, Tokyo, -, Japan.
Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado , San Martín de Porres, , Lima, Peru.
Colombian Institute of the Nervous System, Clinica Montserrat University Hospital, Calle No. -, Bogotá, Colombia.
Department of Psychological Medicine, University of Otago, PO Box , Dunedin, , New Zealand.
National Institute for Health Services Management, Vaselor Str., , Bucharest, Romania.
National Institute of Public Health, National Research Institute, Chocimska St., -, Warsaw, Poland.
Department of Mental Health, National Center of Public Health and Analyses, , Acad. Ivan Geshov Blvd., , Sofia, Bulgaria.
Department of Health Care Policy, Harvard Medical School, Longwood Avenue, Boston, MA, , USA. kessler@hcp.med.harvard.edu.
The Watson Institute for International and Public Affairs, Brown University, Providence, RI, United States.
Abstract summary
High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem.Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31-57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment.Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X = 3.8-199.8, p = 0.050- < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type.A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders.
Authors & Co-authors:
Viana Maria Carmen MC
Kazdin Alan E AE
Harris Meredith G MG
Stein Dan J DJ
Vigo Daniel V DV
Hwang Irving I
Manoukian Sophie M SM
Sampson Nancy A NA
Alonso Jordi J
Andrade Laura Helena LH
Borges Guilherme G
Bunting Brendan B
Caldas-de-Almeida José Miguel JM
de Girolamo Giovanni G
de Jonge Peter P
Gureje Oye O
Haro Josep Maria JM
Karam Elie G EG
Kovess-Masfety Viviane V
Moskalewicz Jacek J
Navarro-Mateu Fernando F
Nishi Daisuke D
Piazza Marina M
Posada-Villa José J
Scott Kate M KM
Vladescu Cristian C
Wojtyniak Bogdan B
Zarkov Zahari Z
Kessler Ronald C RC
Kessler Timothy T
Study Outcome
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