Dataset Information

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

ABSTRACT:

Background

Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment.

Methods

Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits).

Results

Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries.

Conclusions

Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

SUBMITTER: Alonso J

PROVIDER: S-EPMC6008788 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

Alonso Jordi J Liu Zhaorui Z Evans-Lacko Sara S Sadikova Ekaterina E Sampson Nancy N Chatterji Somnath S Abdulmalik Jibril J Aguilar-Gaxiola Sergio S Al-Hamzawi Ali A Andrade Laura H LH Bruffaerts Ronny R Cardoso Graça G Cia Alfredo A Florescu Silvia S de Girolamo Giovanni G Gureje Oye O Haro Josep M JM He Yanling Y de Jonge Peter P Karam Elie G EG Kawakami Norito N Kovess-Masfety Viviane V Lee Sing S Levinson Daphna D Medina-Mora Maria Elena ME Navarro-Mateu Fernando F Pennell Beth-Ellen BE Piazza Marina M Posada-Villa José J Ten Have Margreet M Zarkov Zahari Z Kessler Ronald C RC Thornicroft Graham G

Depression and anxiety 20180122 3

<h4>Background</h4>Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment.<h4>Methods</h4>Data from 23 community surveys in 21 countries of the World Mental ...[more]

PMID: 29356216

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Project description:ImportanceIt is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.ObjectiveTo investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.Design, setting, and participantsEighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.Main outcomes and measuresLifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.ResultsMost associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.Conclusions and relevanceThese findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.

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Dataset Information

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

Background

Methods

Results

Conclusions

Publications

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

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