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.
We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the ...20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.
PURPOSE OF REVIEWThe aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys.
RECENT FINDINGSMedian and ...inter-quartile range (IQR; 25th–75th percentiles) of age-of-onset is much earlier for phobias (7–14, IQR 4–20) and impulse–control disorders (7–15; IQR 4–35) than other anxiety disorders (25–53, IQR 15–75), mood disorders (25–45, IQR 17–65), and substance disorders (18–29, IQR 16–43). Although less data exist for nonaffective psychosis, available evidence suggests that median age-of-onset is in the range late teens through early 20s. Roughly half of all lifetime mental disorders in most studies start by the mid-teens and three quarters by the mid-20s. Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that are seldom brought to clinical attention.
SUMMARYFirst onset of mental disorders usually occur in childhood or adolescence, although treatment typically does not occur until a number of years later. Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments for early incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.
We investigated the underlying mechanisms of the influence of socioeconomic status (SES) on mental health and self-rated health (SRH), and evaluated how these relationships might vary by ...race/ethnicity, age, and gender.
We analyzed data of 44 921 adults who responded to the 2009 California Health Interview Survey. We used a path analysis to test effects of SES, neighborhood safety, and physical activity on mental health and SRH.
Low SES was associated with greater neighborhood safety concerns, which were negatively associated with physical activity, which was then negatively related to mental health and SRH. This model was similar across different racial/ethnic and gender groups, but mean levels in the constructs differed across groups.
SES plays an important role in SRH and mental health, and this effect is further nuanced by race/ethnicity and gender. Identifying the psychological (neighborhood safety) and behavioral (physical activity) factors that influence mental health and SRH is critical for tailoring interventions and designing programs that can improve overall health.
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CEKLJ, FSPLJ, ODKLJ, UL, VSZLJ
Purpose
Although the Global Burden of Disease Study estimated that depressive disorders and anxiety disorders are the second and fifth leading causes of disability in Argentina, these estimates were ...based on imputations rather than epidemiological data. The policy implications of these results for the necessary expansion of mental health services in Argentina are sufficiently great that more direct estimates of the population burdens of common mental disorders are needed. Therefore, the purpose is to present the first results regarding lifetime prevalence, projected lifetime risk up to age 75, age-of-onset, cohort effects and socio-demographic correlates of DSM-IV mental disorders among adults (18+) from the general population of urban areas of Argentina.
Method
A multistage clustered area probability household survey was administered to 3927 individuals using the World Mental Health Composite International Diagnostic Interview.
Results
Lifetime prevalence of any disorder was 29.1% and projected lifetime risk at age 75 was 37.1%. Median age-of-onset of any disorder was 20 years of age. Disorders with highest lifetime prevalence were major depressive disorder (8.7%), alcohol abuse (8.1%), and specific phobia (6.8%). Anxiety disorders were the most prevalent group of disorder (16.4%) followed by mood (12.3%), substance (10.4%), and disruptive behavior disorders (2.5%). Women had greater odds of anxiety and mood disorders; men had greater odds of substance disorders. Age-at-interview was inversely associated with lifetime risk of any disorder.
Discussion
The results provide direct evidence for high lifetime societal burdens of common mental disorders in Argentina due to a combination of high prevalence and early age-of-onset.
Summary Background Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care ...in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Methods Face-to-face household surveys were undertaken with 84 850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. Findings The number of respondents using any 12-month mental health services (57 2%; Nigeria to 1477 18%; USA) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Interpretation Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
Associations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental ...disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries.
Cross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders.
A dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 95% CI: 1.4-1.5 for 1 LTE; 2.1 2.0-2.3 for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 1.2-1.5 to 1.7 1.4-2.0) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 1.3-2.4 to 3.6 2.0-6.5), the exceptions being cancer and stroke.
Traumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.
Background: Because the epidemiologic data available for adolescents from the developing world is scarce, the objective is to estimate the prevalence and severity of psychiatric disorders among ...Mexico City adolescents, the socio‐demographic correlates associated with these disorders and service utilization patterns.
Methods: This is a multistage probability survey of adolescents aged 12 to 17 residing in Mexico City. Participants were administered the computer‐assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design of the survey.
Results: One in every eleven adolescents has suffered a serious mental disorder, one in five a disorder of moderate severity and one in ten a mild disorder. The majority did not receive treatment. The anxiety disorders were the most prevalent but least severe disorders. The most severe disorders were more likely to receive treatment. The most consistent socio‐demographic correlates of mental illness were sex, dropping out of school, and burden unusual at the adolescent stage, such as having had a child, being married or being employed. Parental education was associated with treatment utilization.
Conclusions: These high prevalence estimates coupled with low service utilization rates suggest that a greater priority should be given to adolescent mental health in Mexico and to public health policy that both expands the availability of mental health services directed at the adolescent population and reduces barriers to the utilization of existing services.
Background and aims
Prior research has found bidirectional associations between psychotic experiences (PEs) and selected substance use disorders. We aimed to extend this research by examining the ...bidirectional association between PEs and various types of substance use (SU) and substance use disorders (SUDs), and the influence of antecedent mental disorders on these associations.
Design, setting, participants and measurements
We used data from the World Health Organization World Mental Health surveys. A total of 30 902 adult respondents across 18 countries were assessed for (a) six types of life‐time PEs, (b) a range of types of SU and DSM‐IV SUDs and (c) mental disorders using the Composite International Diagnostic Interview. Discrete‐time survival analyses based on retrospective age‐at‐onset reports examined the bidirectional associations between PEs and SU/SUDs controlling for antecedent mental disorders.
Findings
After adjusting for demographics, comorbid SU/SUDs and antecedent mental disorders, those with prior alcohol use disorders odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.2–2.0, extra‐medical prescription drug use (OR = 1.5, 95% CI = 1.1–1.9), alcohol use (OR = 1.4, 95% CI = 1.1–1.7) and tobacco use (OR = 1.3, 95% CI = 1.0–1.8) had increased odds of subsequent first onset of PEs. In contrast, those with temporally prior PEs had increased odds of subsequent onset of tobacco use (OR = 1.5, 95% CI = 1.2–1.9), alcohol use (OR = 1.3, 95% CI = 1.1–1.6) or cannabis use (OR = 1.3, 95% CI = 1.0–1.5) as well as of all substance use disorders (ORs ranged between 1.4 and 1.5). There was a dose response relationship between both count and frequency of PEs and increased subsequent odds of selected SU/SUDs.
Conclusions
Associations between psychotic experiences (PEs) and substance use/substance use disorders (SU/SUDs) are often bidirectional, but not all types of SU/SUDs are associated with PEs. These findings suggest that it is important to be aware of the presence of PEs within those with SUDs or at risk of SUDs, given the plausibility that they may each impact upon the other.
Purpose
Community surveys of mental disorders and service use are important for public health policy and planning. There is a dearth of information for Latin America. This is the first representative ...community survey in the Argentinean population. The purpose is to estimate the 12-month prevalence and severity of mental disorders, socio-demographic correlates and service use in a general population survey of adults from urban areas of Argentina.
Methods
The World Mental Health Composite International Diagnostic Interview was administered to 3927 individuals aged 18 years and older participating in a multistage clustered area probability household survey. The response rate was 77%.
Results
The 12-month prevalence of any disorder was 14.8%, and a quarter of those disorders were classified as severe. Younger participants and those with lower education had greater odds of any disorder and most classes of disorder. 11.6% of the total population received treatment in the prior 12 months and only 30.2% of those with a severe disorder. Women and those never married were more likely to receive or seek treatment, whereas those with low and low-average education were less likely.
Conclusion
Most individuals with a mental disorder in the past year, even those with a severe disorder, have not received treatment. Because low education is a barrier to treatment, initiatives aimed at mental health education might help timely detection and treatment of these disorders in Argentina.
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