Hostname: page-component-7c8c6479df-fqc5m Total loading time: 0 Render date: 2024-03-17T15:56:06.069Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  27 November 2017

S. Evans-Lacko
Affiliation:
Kings College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK PSSRU, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
S. Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
A. Al-Hamzawi
Affiliation:
College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
J. Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
C. Benjet
Affiliation:
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
W. T. Chiu
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
S. Florescu
Affiliation:
National School of Public Health, Management and Development, Bucharest, Romania
G. de Girolamo
Affiliation:
Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
O. Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
J. M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Y. He
Affiliation:
Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
C. Hu
Affiliation:
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
E. G. Karam
Affiliation:
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
N. Kawakami
Affiliation:
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
S. Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
C. Lund
Affiliation:
Kings College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
V. Kovess-Masfety
Affiliation:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
D. Levinson
Affiliation:
Mental Health Services, Ministry of Health, Jerusalem, Israel
F. Navarro-Mateu
Affiliation:
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
B. E. Pennell
Affiliation:
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
K. M. Scott
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
H. Tachimori
Affiliation:
National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
M. ten Have
Affiliation:
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
M. C. Viana
Affiliation:
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
D. R. Williams
Affiliation:
Department of Society, Human Development, and Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
B. J. Wojtyniak
Affiliation:
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
Z. Zarkov
Affiliation:
Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
S. Chatterji
Affiliation:
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
*
Author for correspondence: R. C. Kessler, E-mail: Kessler@hcp.med.harvard.edu

Abstract

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amaddeo, F and Jones, J (2007) What is the impact of socio-economic inequalities on the use of mental health services? Epidemiologia e Psichiatria Sociale 16, 1619.CrossRefGoogle ScholarPubMed
American Association for Public Opinion Research (AAPOR) (2016) Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys, 9th edn. AAPOR. Available at http://www.aapor.org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal.pdf (Accessed 31 August 2017).Google Scholar
Andrade, LH, Alonso, J, Mneimneh, Z, Wells, JE, Al-Hamzawi, A, Borges, G, Bromet, E, Bruffaerts, R, de Girolamo, G, de Graaf, R, Florescu, S, Gureje, O, Hinkov, HR, Hu, C, Huang, Y, Hwang, I, Jin, R, Karam, EG, Kovess-Masfety, V, Levinson, D, Matschinger, H, O'Neill, S, Posada-Villa, J, Sagar, R, Sampson, NA, Sasu, C, Stein, DJ, Takeshima, T, Viana, MC, Xavier, M and Kessler, RC (2014) Barriers to mental health treatment: results from the WHO world mental health surveys. Psychological Medicine 44, 13031317.Google Scholar
Devaux, M and De Looper, M (2012) Income-related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008–2009, OECD Health Working Papers, No. 58. Paris, France: OECD Publishing. doi: 10.1787/5k95xd6stnxt-en (Accessed 31 May 2017).Google Scholar
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition. (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Harkness, J, Pennell, B-E, Villar, A, Gebler, N, Aguilar-Gaxiola, S and Bilgen, I (2008) Translation procedures and translation assessment in the world mental health survey initiative. In Kessler, RC, Üstün, TB (eds). The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. New York, NY: Cambridge University Press, pp. 91113.Google Scholar
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA and Kessler, RC (2006) Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO world mental health surveys. International Journal of Methods in Psychiatric Research 15, 167180.Google Scholar
Heeringa, SG, Wells, JE, Hubbard, F, Mneimneh, ZN, Chiu, WT, Sampson, NA and Berglund, PA (2008) Sample designs and sampling procedures. In Kessler, RC, Üstün, TB (eds). The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. New York, NY: Cambridge University Press, pp. 1432.Google Scholar
Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S and Ustun, TB (2009) The WHO world mental health (WMH) surveys. Die Psychiatrie: Grundlagen und Perspektiven 6, 59.Google Scholar
Kessler, RC, Frank, RG, Edlund, M, Katz, SJ, Lin, E and Leaf, P (1997) Differences in the use of psychiatric outpatient services between the United States and Ontario. New England Journal of Medicine 336, 551557.Google Scholar
Kessler, RC and Ustun, TB (2004) The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.CrossRefGoogle ScholarPubMed
Kohn, R, Saxena, S, Levav, I and Saraceno, B (2004) The treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.Google ScholarPubMed
Leon, AC, Olfson, M, Portera, L, Farber, L and Sheehan, DV (1997) Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93105.Google Scholar
Levinson, D, Lakoma, MD, Petukhova, M, Schoenbaum, M, Zaslavsky, AM, Angermeyer, M, Borges, G, Bruffaerts, R, de Girolamo, G, de Graaf, R, Gureje, O, Haro, JM, Hu, C, Karam, AN, Kawakami, N, Lee, S, Lepine, JP, Browne, MO, Okoliyski, M, Posada-Villa, J, Sagar, R, Viana, MC, Williams, DR and Kessler, RC (2010) Associations of serious mental illness with earnings: results from the WHO world mental health surveys. British Journal of Psychiatry 197, 114121.CrossRefGoogle ScholarPubMed
Lewer, D, O'Reilly, C, Mojtabai, R and Evans-Lacko, S (2015) Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors. British Journal of Psychiatry 207, 221226.Google Scholar
McGrath, JJ, Saha, S, Al-Hamzawi, A, Andrade, L, Benjet, C, Bromet, EJ, Browne, MO, Caldas de Almeida, JM, Chiu, WT, Demyttenaere, K, Fayyad, J, Florescu, S, de Girolamo, G, Gureje, O, Haro, JM, Ten Have, M, Hu, C, Kovess-Masfety, V, Lim, CC, Navarro-Mateu, F, Sampson, N, Posada-Villa, J, Kendler, KS and Kessler, RC (2016) The bidirectional associations between psychotic experiences and DSM-IV mental disorders. American Journal of Psychiatry 10, 9971006.CrossRefGoogle Scholar
Merikangas, KR, Jin, R, He, JP, Kessler, RC, Lee, S, Sampson, NA, Viana, MC, Andrade, LH, Hu, C, Karam, EG, Ladea, M, Medina-Mora, ME, Ono, Y, Posada-Villa, J, Sagar, R, Wells, JE and Zarkov, Z (2011) Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of General Psychiatry 68, 241251.Google Scholar
Mojtabai, R (2010) Mental illness stigma and willingness to seek mental health care in the European Union. Social Psychiatry and Psychiatric Epidemiology 45, 705712.Google Scholar
Ormel, J, Petukhova, M, Chatterji, S, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Bromet, EJ, Burger, H, Demyttenaere, K, de Girolamo, G, Haro, JM, Hwang, I, Karam, E, Kawakami, N, Lepine, JP, Medina-Mora, ME, Posada-Villa, J, Sampson, N, Scott, K, Ustun, TB, Von Korff, M, Williams, DR, Zhang, M and Kessler, RC (2008) Disability and treatment of specific mental and physical disorders across the world. British Journal of Psychiatry 192, 368375.CrossRefGoogle Scholar
Research Triangle Institute (2002) SUDAAN: Professional Software for Survey Data Analysis [Computer Program]. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
Rhodes, AE and Fung, K (2004) Self-reported use of mental health services versus administrative records: care to recall? International Journal of Methods in Psychiatric Research 13, 165175.CrossRefGoogle ScholarPubMed
Rossi, A, Amaddeo, F, Sandri, M and Tansella, M (2005) Determinants of once-only contact in a community-based psychiatric service. Social Psychiatry and Psychiatric Epidemiology 40, 5056.Google Scholar
Scott, KM, Al-Hamzawi, AO, Andrade, LH, Borges, G, Caldas-de-Almeida, JM, Fiestas, F, Gureje, O, Hu, C, Karam, EG, Kawakami, N, Lee, S, Levinson, D, Lim, CC, Navarro-Mateu, F, Okoliyski, M, Posada-Villa, J, Torres, Y, Williams, DR, Zakhozha, V and Kessler, RC (2014) Associations between subjective social status and DSM-IV mental disorders: results from the world mental health surveys. JAMA Psychiatry 71, 14001408.CrossRefGoogle ScholarPubMed
Scott, KM, de Jonge, P, Stein, DJ and Kessler, RC (eds) (2017) Mental Disorders Around the World: Facts and Figures From the World Mental Health Surveys. New York, NY: Cambridge University Press.Google Scholar
Steele, L, Dewa, C and Lee, K (2007) Socioeconomic status and self-reported barriers to mental health service use. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 52, 201206.CrossRefGoogle ScholarPubMed
Stein, DJ, Karam, EG, Shahly, V, Hill, ED, King, A, Petukhova, M, Atwoli, L, Bromet, EJ, Florescu, S, Haro, JM, Hinkov, H, Karam, A, Medina-Mora, ME, Navarro-Mateu, F, Piazza, M, Shalev, A, Torres, Y, Zaslavsky, AM and Kessler, RC (2016) Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO world mental health surveys. BMC Psychiatry 16, 257271.Google Scholar
Tello, JE, Mazzi, M, Tansella, M, Bonizzato, P, Jones, J and Amaddeo, F (2005) Does socioeconomic status affect the use of community-based psychiatric services? A South Verona case register study. Acta Psychiatrica Scandinavica 112, 215223.Google Scholar
Ten Have, M, Nuyen, J, Beekman, A and de Graaf, R (2013) Common mental disorder severity and its association with treatment contact and treatment intensity for mental health problems. Psychological Medicine 43, 22032213.Google Scholar
Thornicroft, G and Tansella, M (2013) The balanced care model for global mental health. Psychological Medicine 43, 849863.Google Scholar
Van Doorslaer, E and Masseria, C (2004) OECD Health Working Paper No. 14, Income-Related Inequality in the Use of Medical Care in 21 OECD Countries. Paris, France: OECD Publishing. Available at https://www.oecd.org/els/health-systems/31743034.pdf (Accessed 31 May 2017).Google Scholar
Vigo, D, Thornicroft, G and Atun, R (2016) Estimating the true global burden of mental illness. Lancet Psychiatry 3, 171178.Google Scholar
Wang, PS, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Borges, G, Bromet, EJ, Bruffaerts, R, de Girolamo, G, de Graaf, R, Gureje, O, Haro, JM, Karam, EG, Kessler, RC, Kovess, V, Lane, MC, Lee, S, Levinson, D, Ono, Y, Petukhova, M, Posada-Villa, J, Seedat, S and Wells, JE (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370, 841850.Google Scholar
Whiteford, HA, Ferrari, AJ, Degenhardt, L, Feigin, V and Vos, T (2015) The global burden of mental, neurological and substance use disorders: an analysis from the global burden of disease study 2010. PloS ONE 10, e0116820.CrossRefGoogle ScholarPubMed
Wolter, KM (1985) Introduction to Variance Estimation. New York, NY: Springer-Verlag.Google Scholar
World Bank (2009) World Bank List of Economies (July 2009). Washington, DC: The World Bank. Available at http://www.iqla.org/joining/World-Bank_Classification-List_2009.pdf (Accessed 31 May 2017).Google Scholar
World Health Organization (2012) Global Burden of Mental Disorders and the Need for A Comprehensive, Coordinated Response From Health and Social Sectors at the Country Level. Document EB130.R8. Geneva, Switzerland: World Health Organization. Available at http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_R8-en.pdf (Accessed 31 May 2017).Google Scholar
Young, AS and Rabiner, D (2015) Racial/ethnic differences in parent-reported barriers to accessing children's health services. Psychological Services 12, 267273.CrossRefGoogle ScholarPubMed
Supplementary material: File

Evans-Lacko et al supplementary material

Appendix Tables 1-2

Download Evans-Lacko et al supplementary material(File)
File 43.6 KB