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

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Evans-Lacko, S. ^{[1, 2]} ; Aguilar-Gaxiola, S. ^[3] ; Al-Hamzawi, A. ^[4] ; Alonso, J. ^{[5, 6, 7]} ; Benjet, C. ^[8] ; Bruffaerts, R. ^[9] ; Chiu, W. T. ^[10] ; Florescu, S. ^[11] ; de Girolamo, G. ^[12] ; Gureje, O. ^[13] ; Haro, J. M. ^[14] ; He, Y. ^[15] ; Hu, C. ^{[16, 17]} ; Karam, E. G. ^{[18, 19]} ; Kawakami, N. ^[20] ; Lee, S. ^[21] ; Lund, C. ^{[1, 22]} ; Kovess-Masfety, V. ^[23] ; Levinson, D. ^[24] ; Navarro-Mateu, F. ^[25] ; Pennell, B. E. ^[26] ; Sampson, N. A. ^[10] ; Scott, K. M. ^[27] ; Tachimori, H. ^[28] ; ten Have, M. ^[29] ; Viana, M. C. ^[30] ; Williams, D. R. ^[31] ; Wojtyniak, B. J. ^[32] ; Zarkov, Z. ^[33] ; Kessler, R. C. ^[10] ; Chatterji, S. ^[34] ; Thornicroft, G. ; Col, WHO World Mental Hlth Survey

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^[1] Kings Coll London, Inst Psychiat Psychol & Neurosci, De Crespigny Pk, London SE5 8AF - England

^[2] London Sch Econ & Polit Sci, PSSRU, Houghton St, London WC2A 2AE - England

^[3] UC Davis Hlth Syst, Ctr Reducing Hlth Dispar, Sacramento, CA - USA

^[4] Al Qadisiya Univ, Coll Med, Diwaniya Governorate - Iraq

^[5] Pompeu Fabra Univ UPF, Barcelona - Spain

^[6] CIBER Epidemiol & Salud Publ CIBERESP, Barcelona - Spain

^[7] IMIM Hosp Mar Med Res Inst, Hlth Serv Res Unit, Barcelona - Spain

^[8] Natl Inst Psychiat Ramon Fuente Muniz, Dept Epidemiol & Psychosocial Res, Mexico City, DF - Mexico

^[9] UPC KUL, Campus Gasthuisberg, Leuven - Belgium

^[10] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA - USA

^[11] Natl Sch Publ Hlth Management & Dev, Bucharest - Romania

^[12] IRCCS, St John God Clin Res Ctr, Unit Epidemiol & Evaluat Psychiat, Via Pilastroni 4, Brescia - Italy

^[13] Univ Coll Hosp, Dept Psychiat, Ibadan - Nigeria

^[14] Univ Barcelona, Parc Sanitari Sant Joan Deu, CIBERSAM, Barcelona - Spain

^[15] Shanghai Jiao Tong Univ, Sch Med, Shanghai Mental Hlth Ctr, Shanghai - Peoples R China

^[16] Shenzhen Inst Mental Hlth, Shenzhen - Peoples R China

^[17] Shenzhen Kangning Hosp, Shenzhen - Peoples R China

^[18] IDRAAC, Beirut - Lebanon

^[19] Balamand Univ, Fac Med, Dept Psychiat & Clin Psychol, St George Hosp Univ Med Ctr, Beirut - Lebanon

^[20] Univ Tokyo, Sch Publ Hlth, Dept Mental Hlth, Tokyo - Japan

^[21] Chinese Univ Hong Kong, Dept Psychiat, Tai Po, Hong Kong - Peoples R China

^[22] Univ Cape Town, Dept Psychiat & Mental Hlth, Alan J Flisher Ctr Publ Mental Hlth, Cape Town - South Africa

^[23] Paris Descartes Univ, EA 4057, EHESP, Paris - France

^[24] Minist Hlth, Mental Hlth Serv, Jerusalem - Israel

^[25] CIBERESP Murcia, Serv Murciano Salud, IMIB Arrixaca, UDIF SM, Subdireccion Gen Planificac Innovac Croni, Murcia - Spain

^[26] Univ Michigan, Inst Social Res, Survey Res Ctr, Ann Arbor, MI - USA

^[27] Univ Otago, Dept Psychol Med, Dunedin, Otago - New Zealand

^[28] NIMH, Natl Ctr Neurol & Psychiat, Kodaira, Tokyo - Japan

^[29] Netherlands Inst Mental Hlth & Addict, Trimbos Inst, Utrecht - Netherlands

^[30] Univ Fed Espirito Santo, Dept Social Med, Vitoria - Brazil

^[31] Harvard TH Chan Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA - USA

^[32] Natl Inst Publ Hlth, Ctr Monitoring & Analyses Populat Hlth, Natl Inst Hyg, Warsaw - Poland

^[33] Natl Ctr Publ Hlth & Analyses, Directorate Mental Hlth, Sofia - Bulgaria

^[34] WHO, Dept Informat Evidence & Res, Geneva - Switzerland

• Tipo de documento: Artigo Científico
• Fonte: PSYCHOLOGICAL MEDICINE; v. 48, n. 9, p. 1560-1571, JUL 2018.
• Citações Web of Science: 8

Resumo

Background. 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. Methods. 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). Results. 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). Conclusions. 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. (AU)

• Processo FAPESP: 03/00204-3 - Estudo epidemiológico dos transtornos psiquiátricos na região metropolitana de São Paulo: prevalências, fatores de risco e sobrecarga social e econômica
• Beneficiário: Laura Helena Silveira Guerra de Andrade
• Modalidade de apoio: Auxílio à Pesquisa - Temático