To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.
Data were from the World Health Organization (WHO) World Mental Health ...(WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.
Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).
Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
Editorials in This Issue The process of revising the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10) by the World Health Organization (WHO) is ...currently in its final stages with the 11th edition (ICD-11) scheduled for presentation to the World Health Assembly for approval in 2018. At the outset of the revision activities, the International Advisory Group for the Revision of the ICD-10 Mental and Behavioral Disorders decided that improving clinical utility would be a major orienting principle of the process (International Advisory Group for the Revision of ICD-10 Mental & Behavioural Disorders, 2011). According to the WHO: 'the clinical utility of a classification construct or category for mental and behavioral disorders depends on: (a) its value in communicating (e.g., among practitioners, patients, families, administrators); (b) its implementation characteristics in clinical practice, including its goodness of fit (i.e., accuracy of description), its ease of use, and the time required to use it (i.e., feasibility); and (c) its usefulness in selecting interventions and in making clinical management decisions'(Reed, 2010). Acknowledgement Oye Gureje is a member of the International Advisory Group for the Revision of ICD-10 Chapter on Mental and Behavioural Disorders, the Chair of the Somatic Distress and Dissociative Disorders Work Group and the Vice Chair of the Field Studies Coordinating Group.
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. ...Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, ...especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.
Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.
The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.
Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
We examined frequency and reasons for dropout from follow-up care at an outpatient mental health service for older people in South-Western Nigeria. This was a cross-sectional study. Administrative ...reviews of 201 case records of clinic attendees who received a psychiatric diagnosis that required follow-up consultations were conducted. Records were those of patients seen between January 2015 and December 2017. Chart extraction was followed by Key Informant Interview (KII) to explore the reasons for drop out and partial non-attendance. We identified 37(18.4%) regular clinic attendees, as well as 147(73.1%) and 17(8.5%) dropout and partially attending patients, respectively. Approximately 45.6% of the dropouts occurred after the first consultation. In KII, distance from the hospital, long waiting times and financial constraints were the common reasons for dropout. The findings of this study should inform the development of strategies to improve access to mental health services in Nigeria and other low- and middle-income countries.
Background: Falls are a common public health problem amongst the elderly in many communities. There is a need for information on the causes as well as the impact of this preventable risk on health ...among the elderly in sub-Saharan Africa. Objective: To examine the prevalence and factors associated with falls among a population of elderly persons in Nigeria. Methods: A multi-stage stratified sampling of households was implemented to select persons aged 65 years and older in the south-western and north-central parts of Nigeria (n = 2,096). Respondents were asked about the occurrence, number, and consequences of falls in the previous 12 months. They were also assessed for the presence of vision impairment, chronic pain and medical conditions. Results: Falls were reported by 23% (n = 482) of the sample. Females (24.0%) were more likely than males (17.9%) to report falls. Respondents with chronic pain conditions, especially those with arthritis, and those with insomnia were at increased risk for falls. Among fallers, females were more likely than males to sustain injuries, including fractures (45.0 vs. 30.1%; p = 0.001). Persons with near vision impairment were less prone to serious falls with injuries than those with no visual impairment (p < 0.05). Conclusion: Falls are an important health problem among elderly Nigerians. A fall prevention program must have a particular focus on females, those with chronic pain conditions and those experiencing insomnia.
Suicide is a leading cause of death worldwide; however, little information is available about the treatment of suicidal people, or about barriers to treatment.
To examine the receipt of mental health ...treatment and barriers to care among suicidal people around the world.
Twenty-one nationally representative samples worldwide (n=55 302; age 18 years and over) from the World Health Organization's World Mental Health Surveys were interviewed regarding past-year suicidal behaviour and past-year healthcare use. Suicidal respondents who had not used services in the past year were asked why they had not sought care.
Two-fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%) or non-psychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%) and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment.
Most people with suicide ideation, plans and attempts receive no treatment. This is a consistent and pervasive finding, especially in low-income countries. Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking.
Objective
To investigate whether sociodemographic factors were associated with continuing tobacco use in a nationwide Nigerian sample.
Method
The World Mental Health Survey Schedule was used to ...interview 6752 Community dwelling participants 18 years and over, selected in a complex multistage sampling from the six geopolitical zones of Nigeria. Ever and current smokers were identified with their sociodemographic characteristics.
Results
About 17% (1137/6752) of the participants were ever smokers, 24.8% of whom were current smokers. Participants who completed primary school, had some College education, were never married, or students were more likely to continue using smoke once they commenced its use. Being in the older age group or having had graduate college education was associated with much less likelihood of continuing to use tobacco among ever smokers.
Conclusion
In general, tobacco smoking rate in Nigeria is lower compared to most developed countries. Younger participants, having some education, those who were never married were more likely to continue tobacco smoking. Determinants of factors associated with continuing tobacco use should be adequately investigated to permit appropriate interventions.
Objective: We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study.
Method: Perceived stigma (reporting ...health‐related embarrassment and discrimination) was assessed among adults reporting significant disability. Mental disorders were assessed with Composite International Diagnostic Interview (CIDI) 3.0. Chronic conditions were ascertained by self‐report. Household‐residing adults (80 737) participated in 17 population surveys in 16 countries.
Results: Perceived stigma was present in 13.5% (22.1% in developing and 11.7% in developed countries). Suffering from a depressive or an anxiety disorder (vs. no mental disorder) was associated with about a twofold increase in the likelihood of stigma, while comorbid depression and anxiety was even more strongly associated (OR 3.4, 95%CI 2.7–4.2). Chronic physical conditions showed a much lower association.
Conclusion: Perceived stigma is frequent and strongly associated with mental disorders worldwide. Efforts to alleviate stigma among individuals with comorbid depression and anxiety are needed.
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