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WHO world mental health surveys find mental disorders are widespread, disabling and often go untreated

Up to half of all people with serious mental disorders in the United States and several European countries are not receiving treatment, and the situation is even worse in some developing countries, according to major studies by the World Health Organization (WHO).

The findings from the first of a series of WHO World Mental Health Surveys are published in the current issue of The Journal of the American Medical Association (JAMA)1. They clearly show the high prevalence and burden of mental disorders globally which, despite available treatments, remain largely untreated.

The first WHO World Mental Health Survey report includes data from 14 countries (six less developed, eight developed) on the prevalence, severity, and treatment of mental disorders from 60 463 face-to-face interviews with adult individuals representing the general population. The surveys were conducted from 2001 - 2003 in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), the Middle East and Africa (Lebanon, Nigeria), and Asia (Japan, separate surveys in Beijing and Shanghai in the People’s Republic of China). The six countries classified as less developed by the World Bank are China, Colombia, Lebanon, Mexico, Nigeria, and Ukraine.

All surveys used a structured diagnostic interview to assess disorders and treatment. Disorders considered included anxiety disorders, mood disorders, disorders that share a feature of problems with impulse control, and substance abuse disorders.

The researchers found that the prevalence of having any mental disorder in the prior year varied widely from 4.3% in Shanghai to 26.4% in the United States.

“Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild,” the researchers report. “Serious disorders were associated with substantial role disability [inability to carry out usual activities]. 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.”

“The fact that many people with subthreshold disorders are treated while many with serious disorders are not shows that unmet need for treatment among serious cases is not merely a matter of limited treatment resources but that misallocation of treatment resources is also involved,” the authors Drs Ronald C. Kessler and T. Bedirhan Ustün on behalf of 28 country network concluded.

“To the extent that early intervention can prevent progression, early treatment might be cost effective. A new focus on development and evaluation of secondary prevention programs for the early treatment of mild cases is needed to guide rationalization of treatment resource allocation,” the authors conclude.

Dr. Benadetto Saraceno, Director of the WHO Department of Mental Health and Substance Abuse, commended the study as "conclusive evidence on indicating the global burden of disease due to mental and substance abuse disorders" and "good insight into the treatment gap that exists all over the world largely because of stigma and under-recognition of mental and substance abuse disorders".

1(JAMA. 2004;291:2581-2590). Available at http://www.jama.ama-assn.org/cgi/reprint/291/21/2581 Please see JAMA paper for list of authors and for funding information.

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Contacts in participating countries

Colombia
Jose Posada Villa
Email: latos98@yahoo.com
Telephone: +57 1622 6282

Mexico
Maria-Elena Medina Mora
Email: medinam@imp.edu.mx
Telephone: +52 5655 2811

United States
Ron Kessler
Email: kessler@hcp.med.harvard.edu
Telephone: +1 617 4323587

Belgium Koen Demyttenaere
Email: koen.demyttenaere@uz.kuleuven.ac.be
Telephone: +32 163 48 707

France
Vivianne Kovess
Email: vkovess@mgen.fr
Telephone: +331 40 47 24 20

Germany
Matthias Angermeyer
Email: angm@medizin.uni-leipzig.de
Telephone: +49 341 972 4530

Italy
Giovanni de Girolamo
Email: gdg@iss.it
Telephone: +39 051 658 4204

Netherlands
Hans Ormel
Email: j.ormel@med.rug.nl
+31 50 361 1242

Spain
Jordi Alonso
Email: jalonso@imim.es
Telephone: +34 93 225 7553

Ukraine
Evelyn J. Bromet
Email: ebromet@mail.psychiatry.sunysb.edu
Telephone: +631.632.8853

Lebanon
Elie Karam
Email: idrac@idrac.org.lb
Telephone: +961 1 585 700

Nigeria
Oye Gureje
Email: gureje.o@skannet.com.ng
Telephone: +234 2 2410 146

Japan
Norito Kawakami
Email: norito@med.okayama-u.ac.jp
Telephone: +81 86 235 7170

China
Beijing
Yueqin Huang
Email: dengy@mail.tsinghua.edu.cn
Telephone: +86 10 8280 2836

Shanghai
Mingyuan Zhang
Email: myzhang@online.sh.cn
Telephone: + 86 21 643 87250

Hong Kong
Sing Lee
Email: singlee@cuhk.edu.hk
Telephone: +852 144 6996

Region of the Americas
Sergio Aguilar-Gaxiola
Email: sergioa@csufresno.edu
Telephone: + 1 559 779 1797

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For more information contact:

Dr B. Ustun
Telephone: +41 79 509 0648
E-mail: ustunb@who.int

Dr R. Kessler
Telephone: + 1 617 432 3587
E-mail: kessler@hcp.med.harvard.edu