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

S Evans-Lacko, S Aguilar-Gaxiola, A Al-Hamzawi, J Alonso, C Benjet, R Bruffaerts, W T Chiu, S Florescu, G de Girolamo, O Gureje, J M Haro, Y He, C Hu, E G Karam, N Kawakami, S Lee, C Lund, V Kovess-Masfety, D Levinson, F Navarro-Mateu & 12 others B E Pennell, N A Sampson, K M Scott, H Tachimori, M Ten Have, M C Viana, D R Williams, B J Wojtyniak, Z Zarkov, R C Kessler, S Chatterji, G Thornicroft

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalPsychological Medicine
DOIs
Publication statusE-pub ahead of print - Nov 27 2017

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Health Surveys
Substance-Related Disorders
Mental Health
Anxiety
Economics
Education
Diagnostic and Statistical Manual of Mental Disorders
Therapeutics
Mental Disorders
Mental Health Associations
Global Health
Interviews
Surveys and Questionnaires
Vulnerable Populations
Public Health

Keywords

  • Journal Article

Cite this

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. / Evans-Lacko, S; Aguilar-Gaxiola, S; Al-Hamzawi, A; Alonso, J; Benjet, C; Bruffaerts, R; Chiu, W T; Florescu, S; de Girolamo, G; Gureje, O; Haro, J M; He, Y; Hu, C; Karam, E G; Kawakami, N; Lee, S; Lund, C; Kovess-Masfety, V; Levinson, D; Navarro-Mateu, F; Pennell, B E; Sampson, N A; Scott, K M; Tachimori, H; Ten Have, M; Viana, M C; Williams, D R; Wojtyniak, B J; Zarkov, Z; Kessler, R C; Chatterji, S; Thornicroft, G.

In: Psychological Medicine, 27.11.2017, p. 1-12.

Research output: Contribution to journalArticle

Evans-Lacko, S, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Benjet, C, Bruffaerts, R, Chiu, WT, Florescu, S, de Girolamo, G, Gureje, O, Haro, JM, He, Y, Hu, C, Karam, EG, Kawakami, N, Lee, S, Lund, C, Kovess-Masfety, V, Levinson, D, Navarro-Mateu, F, Pennell, BE, Sampson, NA, Scott, KM, Tachimori, H, Ten Have, M, Viana, MC, Williams, DR, Wojtyniak, BJ, Zarkov, Z, Kessler, RC, Chatterji, S & Thornicroft, G 2017, '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', Psychological Medicine, pp. 1-12. https://doi.org/10.1017/S0033291717003336
Evans-Lacko, S ; Aguilar-Gaxiola, S ; Al-Hamzawi, A ; Alonso, J ; Benjet, C ; Bruffaerts, R ; Chiu, W T ; Florescu, S ; de Girolamo, G ; Gureje, O ; Haro, J M ; He, Y ; Hu, C ; Karam, E G ; Kawakami, N ; Lee, S ; Lund, C ; Kovess-Masfety, V ; Levinson, D ; Navarro-Mateu, F ; Pennell, B E ; Sampson, N A ; Scott, K M ; Tachimori, H ; Ten Have, M ; Viana, M C ; Williams, D R ; Wojtyniak, B J ; Zarkov, Z ; Kessler, R C ; Chatterji, S ; Thornicroft, G. / 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. In: Psychological Medicine. 2017 ; pp. 1-12.
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T1 - Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders

T2 - results from the WHO World Mental Health (WMH) surveys

AU - Evans-Lacko, S

AU - Aguilar-Gaxiola, S

AU - Al-Hamzawi, A

AU - Alonso, J

AU - Benjet, C

AU - Bruffaerts, R

AU - Chiu, W T

AU - Florescu, S

AU - de Girolamo, G

AU - Gureje, O

AU - Haro, J M

AU - He, Y

AU - Hu, C

AU - Karam, E G

AU - Kawakami, N

AU - Lee, S

AU - Lund, C

AU - Kovess-Masfety, V

AU - Levinson, D

AU - Navarro-Mateu, F

AU - Pennell, B E

AU - Sampson, N A

AU - Scott, K M

AU - Tachimori, H

AU - Ten Have, M

AU - Viana, M C

AU - Williams, D R

AU - Wojtyniak, B J

AU - Zarkov, Z

AU - Kessler, R C

AU - Chatterji, S

AU - Thornicroft, G

PY - 2017/11/27

Y1 - 2017/11/27

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1017/S0033291717003336

DO - 10.1017/S0033291717003336

M3 - Article

SP - 1

EP - 12

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

ER -