Dropout from treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys

Corina Benjet, Guilherme Borges, Ricardo Orozco, Sergio Aguilar-Gaxiola, Laura H. Andrade, Alfredo Cia, Irving Hwang, Ronald C. Kessler, Marina Piazza, José Posada-Villa, Nancy Sampson, Juan Carlos Stagnaro, Yolanda Torres, María Carmen Viana, Daniel Vigo, María Elena Medina-Mora

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To estimate structural and attitudinal reasons for premature discontinuation of mental health treatment, socio-demographic and clinical correlates of treatment dropout due to these reasons, and to test country differences from the overall effect across the region of the Americas. Methods: World Health Organization-World Mental Health (WMH) surveys were carried out in six countries in the Americas: Argentina, Brazil, Colombia, Mexico, Peru and USA. Among the 1991 participants who met diagnostic criteria (measured with the Composite International Diagnostic Interview (WMH–CIDI)) for a mental disorder and were in treatment in the prior 12-months, the 236 (12.2%) who dropped out of treatment before the professional recommended were included. Findings: In all countries, individuals more frequently reported attitudinal (79.2%) rather than structural reasons (30.7%) for dropout. Disorder severity was associated with structural reasons; those with severe disorder (versus mild disorder) had 3.4 (95%CI=1.1–11.1) times the odds of reporting a structural reason. Regarding attitudinal reasons, those with lower income (versus higher income) were less likely to discontinue treatment because of getting better (OR=0.4; 95%CI= 0.2–0.9). Country specific variations were found. Limitations: Not all countries, or the poorest, in the region were included. Some estimations couldn´t be calculated due to cell size. Causality cannot be assumed. Conclusion: Clinicians should in the first sessions address attitudinal factors that may lead to premature termination. Public policies need to consider distribution of services to increase convenience. A more rational use of resources would be to offer brief therapies to individuals most likely to drop out of treatment prematurely.

Original languageEnglish (US)
Pages (from-to)168-179
Number of pages12
JournalJournal of Affective Disorders
Volume303
DOIs
StatePublished - Apr 15 2022
Externally publishedYes

Keywords

  • Latin America
  • Treatment adherence
  • Treatment barriers
  • Treatment dropout

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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