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Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- And high-income countries from the World Health Organization's World Mental Health Survey Initiative

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dc.contributor.author Fernández, D.
dc.contributor.author Vigo, D.
dc.contributor.author Sampson, N.A.
dc.contributor.author Hwang, I.
dc.contributor.author Aguilar-Gaxiola, S.
dc.contributor.author Al-Hamzawi, A.O.
dc.contributor.author Alonso, J.
dc.contributor.author Andrade, L.H.
dc.contributor.author Bromet, E.J.
dc.contributor.author De Girolamo, G.
dc.contributor.author De Jonge, P.
dc.contributor.author Florescu, S.
dc.contributor.author Gureje, O.
dc.contributor.author Hinkov, H.
dc.contributor.author Hu, C.
dc.contributor.author Karam, E.G.
dc.contributor.author Karam, G.
dc.contributor.author Kawakami, N.
dc.contributor.author Kiejna, A.
dc.contributor.author Kovess-Masfety, V.
dc.contributor.author Medina-Mora, M.E.
dc.contributor.author Navarro-Mateu, F.
dc.contributor.author Ojagbemi, A.
dc.contributor.author O'neill, S.
dc.contributor.author Piazza Ferrand, Marina Julia
dc.contributor.author Posada-Villa, J.
dc.contributor.author Rapsey, C.
dc.contributor.author Williams, D.R.
dc.contributor.author Xavier, M.
dc.contributor.author Ziv, Y.
dc.contributor.author Kessler, R.C.
dc.contributor.author Haro, J.M.
dc.contributor.author World Health Organization World Mental Health Survey collaborators
dc.date.accessioned 2021-12-12T20:24:53Z
dc.date.available 2021-12-12T20:24:53Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/10195
dc.description.abstract Background There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. Methods Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. Results Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. Conclusions Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases en_US
dc.language.iso eng
dc.publisher Cambridge University Press
dc.relation.ispartofseries Psychological Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Dropout en_US
dc.subject mental health en_US
dc.subject survival analysis en_US
dc.subject WMH surveys en_US
dc.title Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- And high-income countries from the World Health Organization's World Mental Health Survey Initiative en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1017/S0033291720000884
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#5.01.00
dc.relation.issn 1469-8978


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