| Full text | |
| Author(s): Show less - |
Vigo, Daniel
;
Haro, Josep Maria
;
Hwang, Irving
;
Aguilar-Gaxiola, Sergio
;
Alonso, Jordi
;
Borges, Guilherme
;
Bruffaerts, Ronny
;
Caldas-de-Almeida, Jose Miguel
;
de Girolamo, Giovanni
;
Florescu, Silvia
;
Gureje, Oye
;
Karam, Elie
;
Karam, Georges
;
Kovess-Masfety, Viviane
;
Lee, Sing
;
Navarro-Mateu, Fernando
;
Ojagbemi, Akin
;
Posada-Villa, Jose
;
Sampson, Nancy A.
;
Scott, Kate
;
Carlos Stagnaro, Juan
;
ten Have, Margreet
;
Viana, Maria Carmen
;
Wu, Chi-Shin
;
Chatterji, Somnath
;
Cuijpers, Pim
;
Thornicroft, Graham
;
Kessler, Ronald C.
;
WHO World Mental Hlth Survey Colla
Total Authors: 29
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| Document type: | Journal article |
| Source: | PSYCHOLOGICAL MEDICINE; v. 52, n. 10, p. 11-pg., 2022-07-01. |
| Abstract | |
Background 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. Methods 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. Results 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. Conclusions 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. (AU) | |
| 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 |