Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys

The WHO World Mental Health Survey Consortium

Research output: Contribution to journalReview article

1962 Citations (Scopus)

Abstract

Context: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. Objective: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Design, Setting, and Participants: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. Main Outcome Measures: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Conclusions: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.

Original languageEnglish (US)
Pages (from-to)2581-2590
Number of pages10
JournalJournal of the American Medical Association
Volume291
Issue number21
DOIs
StatePublished - Jun 2 2004
Externally publishedYes

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Health Surveys
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Mental Health
Developing Countries
Interviews
Eastern Africa
Middle East
Colombia
Far East
Nigeria
Developed Countries
Psychiatry
Outcome Assessment (Health Care)
Global Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. / The WHO World Mental Health Survey Consortium.

In: Journal of the American Medical Association, Vol. 291, No. 21, 02.06.2004, p. 2581-2590.

Research output: Contribution to journalReview article

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title = "Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys",
abstract = "Context: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. Objective: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Design, Setting, and Participants: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. Main Outcome Measures: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3{\%} in Shanghai to 26.4{\%} in the United States, with an interquartile range (IQR) of 9.1{\%}-16.9{\%}. Between 33.1{\%} (Colombia) and 80.9{\%} (Nigeria) of 12-month cases were mild (IQR, 40.2{\%}-53.3{\%}). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5{\%} to 50.3{\%} of serious cases in developed countries and 76.3{\%} to 85.4{\%} in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Conclusions: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.",
author = "{The WHO World Mental Health Survey Consortium} and Koen Demyttenaere and Ronny Bruffaerts and Jose Posada-Villa and Isabelle Gasquet and Viviane Kovess and Lepine, {Jean Pierre} and Angermeyer, {Matthias C.} and Sebastian Bernert and {de Girolamo}, Giovanni and Pierluigi Morosini and Gabriella Polidori and Takehiko Kikkawa and Norito Kawakami and Yutaka Ono and Tadashi Takeshima and Hidenori Uda and Karam, {Elie G.} and Fayyad, {John A.} and Karam, {Aimee N.} and Mneimneh, {Zeina N.} and Medina-Mora, {Maria Elena} and Guilherme Borges and Carmen Lara and {de Graaf}, Ron and Johan Ormel and Oye Gureje and Yucun Shen and Yueqin Huang and Mingyuan Zhang and Jordi Alonso and Haro, {Josep Maria} and Gemma Vilagut and Bromet, {Evelyn J.} and Semyon Gluzman and Charles Webb and Kessler, {Ronald C.} and Merikangas, {Kathleen R.} and Anthony, {James C.} and {Von Korff}, {Michael R.} and Wang, {Philip S.} and Bedirhan Ustun and Heeringa and Pennell and Chatterji and Fayyd and Aguilar-Gaxiola and Sergio Aguilar-Gaxiola and Brugha and Zaslavsky",
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T1 - Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys

AU - The WHO World Mental Health Survey Consortium

AU - Demyttenaere, Koen

AU - Bruffaerts, Ronny

AU - Posada-Villa, Jose

AU - Gasquet, Isabelle

AU - Kovess, Viviane

AU - Lepine, Jean Pierre

AU - Angermeyer, Matthias C.

AU - Bernert, Sebastian

AU - de Girolamo, Giovanni

AU - Morosini, Pierluigi

AU - Polidori, Gabriella

AU - Kikkawa, Takehiko

AU - Kawakami, Norito

AU - Ono, Yutaka

AU - Takeshima, Tadashi

AU - Uda, Hidenori

AU - Karam, Elie G.

AU - Fayyad, John A.

AU - Karam, Aimee N.

AU - Mneimneh, Zeina N.

AU - Medina-Mora, Maria Elena

AU - Borges, Guilherme

AU - Lara, Carmen

AU - de Graaf, Ron

AU - Ormel, Johan

AU - Gureje, Oye

AU - Shen, Yucun

AU - Huang, Yueqin

AU - Zhang, Mingyuan

AU - Alonso, Jordi

AU - Haro, Josep Maria

AU - Vilagut, Gemma

AU - Bromet, Evelyn J.

AU - Gluzman, Semyon

AU - Webb, Charles

AU - Kessler, Ronald C.

AU - Merikangas, Kathleen R.

AU - Anthony, James C.

AU - Von Korff, Michael R.

AU - Wang, Philip S.

AU - Ustun, Bedirhan

AU - Heeringa,

AU - Pennell,

AU - Chatterji,

AU - Fayyd,

AU - Aguilar-Gaxiola,

AU - Aguilar-Gaxiola, Sergio

AU - Brugha,

AU - Zaslavsky,

PY - 2004/6/2

Y1 - 2004/6/2

N2 - Context: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. Objective: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Design, Setting, and Participants: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. Main Outcome Measures: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Conclusions: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.

AB - Context: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. Objective: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Design, Setting, and Participants: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. Main Outcome Measures: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Conclusions: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.

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