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

WHO World Mental Health Survey Collaborators

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)195-208
Number of pages14
JournalDepression and Anxiety
Volume35
Issue number3
DOIs
Publication statusPublished - Mar 2018

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Health Surveys
Anxiety Disorders
Mental Health
Diagnostic and Statistical Manual of Mental Disorders
Therapeutics
Complementary Therapies
Global Health
Post-Traumatic Stress Disorders
Mental Disorders
Psychotherapy
Emotions
Anxiety
Alcohols
Interviews
Drug Therapy

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders/therapy
  • Female
  • Global Health/statistics & numerical data
  • Health Care Surveys/statistics & numerical data
  • Humans
  • Male
  • Mental Health/statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care/statistics & numerical data
  • Quality of Health Care/statistics & numerical data
  • Young Adult

Cite this

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

In: Depression and Anxiety, Vol. 35, No. 3, 03.2018, p. 195-208.

Research output: Contribution to journalArticle

WHO World Mental Health Survey Collaborators. / Treatment gap for anxiety disorders is global : Results of the World Mental Health Surveys in 21 countries. In: Depression and Anxiety. 2018 ; Vol. 35, No. 3. pp. 195-208.
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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.",
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author = "{WHO World Mental Health Survey Collaborators} and Jordi Alonso and Zhaorui Liu and Sara Evans-Lacko and Ekaterina Sadikova and Nancy Sampson and Somnath Chatterji and Jibril Abdulmalik and Sergio Aguilar-Gaxiola and Ali Al-Hamzawi and Andrade, {Laura H} and Ronny Bruffaerts and Gra{\cc}a Cardoso and Alfredo Cia and Silvia Florescu and {de Girolamo}, Giovanni and Oye Gureje and Haro, {Josep M} and Yanling He and {de Jonge}, Peter and Karam, {Elie G} and Norito Kawakami and Viviane Kovess-Masfety and Sing Lee and Daphna Levinson and Medina-Mora, {Maria Elena} and Fernando Navarro-Mateu and Beth-Ellen Pennell and Marina Piazza and Jos{\'e} Posada-Villa and {Ten Have}, Margreet and Zahari Zarkov and Kessler, {Ronald C} and Graham Thornicroft",
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AU - Evans-Lacko, Sara

AU - Sadikova, Ekaterina

AU - Sampson, Nancy

AU - Chatterji, Somnath

AU - Abdulmalik, Jibril

AU - Aguilar-Gaxiola, Sergio

AU - Al-Hamzawi, Ali

AU - Andrade, Laura H

AU - Bruffaerts, Ronny

AU - Cardoso, Graça

AU - Cia, Alfredo

AU - Florescu, Silvia

AU - de Girolamo, Giovanni

AU - Gureje, Oye

AU - Haro, Josep M

AU - He, Yanling

AU - de Jonge, Peter

AU - Karam, Elie G

AU - Kawakami, Norito

AU - Kovess-Masfety, Viviane

AU - Lee, Sing

AU - Levinson, Daphna

AU - Medina-Mora, Maria Elena

AU - Navarro-Mateu, Fernando

AU - Pennell, Beth-Ellen

AU - Piazza, Marina

AU - Posada-Villa, José

AU - Ten Have, Margreet

AU - Zarkov, Zahari

AU - Kessler, Ronald C

AU - Thornicroft, Graham

N1 - © 2018 Wiley Periodicals, Inc.

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N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anxiety Disorders/therapy

KW - Female

KW - Global Health/statistics & numerical data

KW - Health Care Surveys/statistics & numerical data

KW - Humans

KW - Male

KW - Mental Health/statistics & numerical data

KW - Middle Aged

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Quality of Health Care/statistics & numerical data

KW - Young Adult

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DO - 10.1002/da.22711

M3 - Article

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VL - 35

SP - 195

EP - 208

JO - Depression and Anxiety

JF - Depression and Anxiety

SN - 1091-4269

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ER -