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

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

Alonso, J.; Liu, Z.; Evans-Lacko, S.; Sadikova, E.; Sampson, N.; Chatterji, S.; Abdulmalik, J.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Andrade, L.H.; Bruffaerts, R.; Cardoso, G.; Cia, A.; Florescu, S.; de Girolamo, G.; Gureje, O.; Haro, J.M.; He, Y.; de Jonge, P.; Karam, E.G.; Kawakami, N.; Kovess-Masfety, V.; Lee, S.; Levinson, D.; Medina-Mora, M.E.; Navarro-Mateu, F.; Pennell, B.E.; Piazza Ferrand, Marina Julia; Posada-Villa, J.; ten Have, M.; Zarkov, Z.; Kessler, R.C.; Thornicroft, G.; WHO World Mental Health Survey
URI: https://hdl.handle.net/20.500.12866/6465
Date: 2018

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.

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