Minding the treatment gap: results of the Singapore Mental Health Study

Mythily Subramaniam,Derrick Heng,Siow Ann Chong,Swapna Verma,Hong Choon Chua,Saleha Shafie,Edimansyah Abdin,Weng Mooi Tan,Kelvin Bryan Tan,Janhavi Ajit Vaingankar

doi:10.1007/s00127-019-01748-0

Abstract

PurposeTo establish the 12-month treatment gap and its associated factors among adults with mental disorders in the Singapore resident population using data from the second Singapore Mental Health Study and to examine the changes since the last mental health survey conducted in 2010.Methods6126 respondents were administered selected modules of the Composite International Diagnostic Interview, to assess major depressive disorder (MDD), dysthymia, bipolar disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence). Past year treatment gap was defined as the absolute difference between the prevalence of a particular mental disorder in the past 12 months preceding the interview and those who had received treatment for that disorder.ResultsThe prevalence of overall 12-month treatment gap in this population was high (78.6%). A multiple logistic regression analysis revealed significantly higher odds of treatment gap among those diagnosed with OCD (compared to those with MDD) and in those with a comorbid chronic physical disorder; while those who had primary education and below and those who were unemployed were less likely to have a treatment gap as compared to those with post-secondary education and those employed, respectively.ConclusionsThe high treatment gap in the population is concerning and highlights the need to promote help-seeking and uptake of treatment. Given the unique demographic characteristics, i.e., those with higher education and employed were more likely not to seek treatment, targeted interventions in the educational and workplace settings should be implemented.

Highlights

The World Health Organization’s global health report has estimated that 4.4% of the world’s population suffers from depression and 3.6% from anxiety disorders which means1 3 Vol.:(0123456789)Social Psychiatry and Psychiatric Epidemiology (2020) 55:1415–1424 that globally 300 million suffer from depression and 264 million from anxiety disorders [1]
Univariate analyses showed that the prevalence of treatment gap was significantly higher among those employed as compared to those who were unemployed (81.9% vs. 56.9%, p = 0.036), those with mild symptoms as compared to those with moderate/severe symptoms (83.5% vs. 67.1%, p = 0.0155) and those diagnosed with obsessive compulsive disorder (OCD) as compared to those with major depressive disorder (MDD) (88.3% vs. 73.4% p = 0.0076) (Supplementary Table 1)
After controlling for all covariates in multiple logistic regression analysis, we observed significantly higher odds of treatment gap among those diagnosed with OCD and in those with a comorbid chronic physical disorder

Summary

Introduction

The World Health Organization’s global health report has estimated that 4.4% of the world’s population suffers from depression and 3.6% from anxiety disorders which means. Social Psychiatry and Psychiatric Epidemiology (2020) 55:1415–1424 that globally 300 million suffer from depression and 264 million from anxiety disorders [1]. The World Mental Health Surveys (WMHS) found that few people received treatment for their emotional or substance use problems in the 12-month period prior to the survey. It ranged from a low of 0.8% in Nigeria to a high of 15.3% in the United States [4]

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