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Depress Anxiety. 2018 Mar;35(3):195-208. doi: 10.1002/da.22711. Epub 2018 Jan 22.

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

Author information

1
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
2
Pompeu Fabra University (UPF), Barcelona, Spain.
3
CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
4
Institute of Mental Health, Peking University, Beijing, China.
5
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.
6
PSSRU, London School of Economics and Political Science, London, United Kingdom.
7
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
8
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.
9
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
10
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
11
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq.
12
Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
13
Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
14
Department of Mental Health, Faculdades de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
15
Anxiety Disorders Center, Buenos Aires, Argentina.
16
National School of Public Health, Management and Development, Bucharest, Romania.
17
Unit of Epidemiological and Evaluation Psychiatry, IRCCS-St. John of God Clinical Research Centre, Brescia, Italy.
18
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
19
Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
20
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands.
21
Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands.
22
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon.
23
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
24
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan.
25
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France.
26
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
27
Mental Health Services, Ministry of Health, Jerusalem, Israel.
28
National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
29
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca, Murcia, Spain, CIBERESP-Murcia, Murcia, Spain.
30
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
31
Universidad Cayetano Heredia, Lima, Peru.
32
National Institute of Health, Lima, Peru.
33
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
34
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
35
Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.

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.

KEYWORDS:

adequate treatment; anxiety disorders; health services; perceived need for care; surveys

PMID:
29356216
PMCID:
PMC6008788
DOI:
10.1002/da.22711
[Indexed for MEDLINE]
Free PMC Article

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