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

Author(s):Show less -

Fernandez, Daniel ^{[1, 2]} ; Vigo, Daniel ^{[3, 4]} ; Sampson, Nancy A. ^[5] ; Hwang, Irving ^[5] ; Aguilar-Gaxiola, Sergio ^[6] ; Al-Hamzawi, Ali O. ^[7] ; Alonso, Jordi ^{[8, 9, 10]} ; Andrade, Laura Helena ^[11] ; Bromet, Evelyn J. ^[12] ; de Girolamo, Giovanni ^[13] ; de Jonge, Peter ^{[14, 15]} ; Florescu, Silvia ^[16] ; Gureje, Oye ^[17] ; Hinkov, Hristo ^[18] ; Hu, Chiyi ^{[19, 20]} ; Karam, Elie G. ^{[21, 22]} ; Karam, Georges ^{[21, 22]} ; Kawakami, Norito ^[23] ; Kiejna, Andrzej ^{[24, 25]} ; Kovess-Masfety, Viviane ^[26] ; Medina-Mora, Maria E. ^[27] ; Navarro-Mateu, Fernando ^[28] ; Ojagbemi, Akin ^[17] ; O'Neill, Siobhan ^[29] ; Piazza, Marina ^[30] ; Posada-Villa, Jose ^[31] ; Rapsey, Charlene ^[32] ; Williams, David R. ^[33] ; Xavier, Miguel ^[34] ; Ziv, Yuval ^[35] ; Kessler, Ronald C. ^[5] ; Haro, Josep M. ^[1] ; Hlth, World Hlth Org World Mental

Affiliation:Show less -

^[1] CIBERSAM, Parc Sanit St Joan Deu, St Boi Llobregat, Barcelona - Spain

^[2] Polytechn Univ Catalonia BarcelonaTech, Dept Stat & Operat Res, Serra Hunter, Barcelona - Spain

^[3] Univ British Columbia, Dept Psychiat, Vancouver, BC - Canada

^[4] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA 02115 - USA

^[5] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[6] Univ Calif Davis Hlth Syst, Ctr Reducing Hlth Dispar, Sacramento, CA - USA

^[7] Al Qadisiya Univ, Coll Med, Diwaniya Governorate - Iraq

^[8] Pompeu Fabra Univ UPF, Barcelona - Spain

^[9] CIBER Epidemiol & Salud Publ CIBERESP, Madrid - Spain

^[10] IMIM Hosp Mar Med Res Inst, Hlth Serv Res Unit, Barcelona - Spain

^[11] Univ Sao Paulo, Hosp Clin, Inst Psiquiatr, Nucl Epidemiol Psiquiatr LIM 23, Fac Med, Sao Paulo - Brazil

^[12] SUNY Stony Brook, Sch Med, Dept Psychiat, Stony Brook, NY 11794 - USA

^[13] IRCCS, Ist Ctr San Giovanni Dio Fatebenefratelli, Brescia - Italy

^[14] Univ Med Ctr Groningen, Interdisciplinary Ctr Psychopathol & Emot Regulat, Dept Psychiat, Groningen - Netherlands

^[15] Rijksuniversiteit Groningen, Dept Dev Psychol, Groningen - Netherlands

^[16] Natl Sch Publ Hlth Management & Dev, Bucharest - Romania

^[17] Univ Coll Hosp, Dept Psychiat, Ibadan - Nigeria

^[18] Natl Ctr Publ Hlth & Analyses, Sofia - Bulgaria

^[19] Shenzhen Inst Mental Hlth, Shenzhen - Peoples R China

^[20] Shenzhen Kangning Hosp, Shenzhen - Peoples R China

^[21] Inst Dev Res Advocacy & Appl Care IDRAAC, Beirut - Lebanon

^[22] Balamand Univ, St George Hosp Univ, Med Ctr, Dept Psychiat & Clin Psychol, Beirut - Lebanon

^[23] Univ Tokyo, Sch Publ Hlth, Dept Mental Hlth, Tokyo - Japan

^[24] Wroclaw Med Univ, Wroclaw - Poland

^[25] Univ Lower Silesia, Wroclaw - Poland

^[26] Paris Descartes Univ, Ecole Hautes Etud Sante Publ EHESP, EA 4057, Paris - France

^[27] Natl Inst Psychiat Ramon Fuente Muniz, Mexico City, DF - Mexico

^[28] UDIF SM, Subdirecc Gen Planificac Innovac & Cronicidad Ser, IMIB Arrixaca CIBERESP Murcia, Murcia - Spain

^[29] Ulster Univ, Sch Psychol, Londonderry - North Ireland

^[30] Univ Cayetano Heredia, Lima - Peru

^[31] Colegio Mayor Cundinamarca Univ, Fac Social Sci, Bogota - Colombia

^[32] Univ Otago, Dunedin Sch Med, Dept Psychol Med, Dunedin - New Zealand

^[33] Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, Boston, MA - USA

^[34] Univ Nova Lisboa, NOVA Med Sch, Fac Ciencias Med, Lisbon - Portugal

^[35] Israeli Minist Hlth, Mental Hlth Serv, Jerusalem - Israel

• Document type: Journal article
• Source: PSYCHOLOGICAL MEDICINE; v. 51, n. 12, p. 2104-2116, SEP 2021.
• Web of Science Citations: 1

Abstract

Background 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. Methods Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 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. Results 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% v. 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. Conclusions 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. (AU)

• FAPESP's process: 16/50307-3 - Mental health, migration and the megacity (São Paulo) - M3SP
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Regular Research Grants
• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants