Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

G Borges,S Aguilar-Gaxiola,J C Stagnaro,N Sampson,A Cia,R Orozco,R C Kessler,Maria Carmen Viana,Y Torres,C Benjet,M E Medina-Mora,L Andrade

doi:10.1017/s2045796019000477

Abstract

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Highlights

Around the world, mental disorders are very common (Demyttenaere et al, 2004), produce a large disease burden (Vos et al, 2015; Alonso et al, 2018) but are undertreated or receive treatment that does not adhere to evidence-based recommendations (Wang et al, 2002)
Some countries offer a large range of mental health services based on community mental health care and general physicians, while other countries still rely on psychiatrists in large mental health hospitals that focus mainly on severe mental disorders as their basis of mental health care (Rodríguez, 2007)
The prevalence across sites for any service use among those with any disorder varied from 13.1% in Colombia-national to 39.7% in the USA

Summary

Introduction

Mental disorders are very common (Demyttenaere et al, 2004), produce a large disease burden (Vos et al, 2015; Alonso et al, 2018) but are undertreated or receive treatment that does not adhere to evidence-based recommendations (Wang et al, 2002) This situation is even worse in low and middle-income countries (Degenhardt et al, 2017; Thornicroft et al, 2017), where a few resources available are often spent on highly specialised mental health professionals acting in tertiary care settings that tend to privilege severe cases, while general medical professionals in primary care lack training and resources for treating mental disorders (WHO and AIMS 2013).

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