Journal Article

The treatment gap in mental health care

KOHN, Robert, SARACENO, Benedetto, LEVAV, Itzhak, SAXENA, Shekhar

2004

Overview

Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States.

• Publisher: Organisation mondiale de la santé,World Health Organization,The World Health Organization
• Subject: Accesibilidad a los servicios de salud / Access to health care / Adolescent / Adult / Adult and adolescent clinical studies / Alcohol abuse / Alcoholism / Alcoholismo / Americas / Americas - epidemiology / Anxiety / Anxiety disorders / Biological and medical sciences / Bipolar disorder / Care and treatment / Chronically ill / Community mental health services / Compulsions / Costo de la enfermedad / Developing countries / Disorders / Epidemiologic Studies / Epidemiology / Esquizofrenia / Estudios epidemiológicos / Europa / Europe / Europe - epidemiology / Generalized anxiety disorder / Health expenditure / Health Policy & Services / Health problems / Health Services Accessibility / Health Services Needs and Demand / Health Surveys / Humans / Knowledge utilization / LDCs / Medical sciences / Mental depression / Mental disorders / Mental Disorders - classification / Mental Disorders - epidemiology / Mental Disorders - therapy / Mental health / Mental health care / Mental health services / Mental Health Services - utilization / Mental illness / Mentally ill / Middle Aged / Miscellaneous / Mood / Obsessive compulsive disorder / Panic disorders / Personality disorders / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Psychosis / Psychotherapy / Public health / Regions / Rehabilitation / Research Article / Schizophrenia / Servicios de salud mental / Trastorno de personalidad compulsiva / Trastornos de ansiedad / Trastornos del humor / Treatment methods / World health organization