WHO world mental health surveys find mental disorders are widespread, disabling and often go untreated
2 June 2004 | Geneva - 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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