Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys
Open accessAbstract
CONTEXT: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. OBJECTIVE: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. DESIGN, SETTING, AND PARTICIPANTS: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. MAIN OUTCOME MEASURES: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. RESULTS: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. CONCLUSIONS: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
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In Nigeria, only 1 out of every 5 persons with a mental disorder is able to access any care.
“only 1 out of every 5 persons with a mental disorder is able to access any care [3]”
From Sustainable financing mechanisms for strengthening mental health systems in Nigeria (2019) · cites this paper as [3]
The Severity and Treatment section reports that 76.3%–85.4% of serious cases in less-developed countries received no treatment in the preceding year, broadly consistent with about one in five receiving treatment. It does not establish that one in five Nigerians with any mental disorder accessed care: the figure concerns serious cases across less-developed countries, and treatment received is not the same as ability to access care. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe treatment gap for mental disorders in low- and middle-income countries is between 76 and 85%.
“the treatment gap for low- and middle-income countries (LMICs) is between 76 and 85%”
From Sustainable financing mechanisms for strengthening mental health systems in Nigeria (2019) · cites this paper as [3]
The Abstract and “Severity and Treatment” section report that 76.3%–85.4% of serious cases in less-developed countries received no treatment. The citing sentence omits the restriction to serious cases, making the figure sound applicable to all mental disorders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMany countries do not have adequate mental health resources and services.
“many countries do not have adequate mental health resources and services [7].”
From Virtual Reality for Addressing Depression and Anxiety: A Bibliometric Analysis (2023) · cites this paper as [7]
The Abstract and Severity and Treatment section (page not available in our copy) report that substantial proportions of serious cases went untreated across the surveyed countries, supporting the claim of inadequate access to services. The Comment section cautions that unmet need is not merely a matter of limited treatment resources; misallocation also contributes. The paper therefore does not establish that countries generally lack adequate resources. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDifficulties in accessing mental health services are a major global concern, particularly in relation to drug and alcohol addiction issues.
“Difficulties in accessing mental health services are a major global concern, particularly in relation to drug and alcohol addiction issues (57, 58).”
From Mobile intervention for individuals with psychosis, dual disorders, and their common comorbidities: A literature review (2019) · cites this paper as [57]
The Abstract and Comment report substantial unmet treatment need across the surveyed countries and identify structural barriers to access. The Measures section includes alcohol and drug abuse or dependence, but the cited passages do not establish that access difficulties are particularly pronounced for those disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInternalizing disorders are the most prevalent psychopathologies experienced worldwide.
“Internalizing disorders (IDs, e.g. generalized anxiety disorder, GAD; social anxiety disorder, SOC; major depressive disorder, MDD; posttraumatic stress disorder, PTSD) are the most prevalent psychopathologies experienced worldwide [1, 8–11]”
Those prevalence estimates are much higher than the 7.6% for any anxiety disorder including PTSD and 5.3% for any mood disorder including major depressive disorder in 17 general populations in the World Mental Health Survey.
“These prevalences are substantially higher than the average 7.6% (any anxiety disorder, including PTSD) and 5.3% (any mood disorder, including major depressive disorder) reported in 17 general populations participating in the World Mental Health Survey.”
From Mental health and psychosocial support in humanitarian settings: linking practice and research (2011) · cites this paper as [8]
Under-treatment of mental disorders such as depression contributes to limited receipt of evidence-based treatment.
“This is caused both by under-treatment of mental disorders such as depression (Demyttenaere et al., 2004, Harvey and Gumport, 2015) and therapist drift from evidence-based treatment protocols (Waller, 2009).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Demyttenaere et al., 2004
Resources and infrastructure to treat unhealthy alcohol use in Mozambique are limited, with 75-90% of people with behavioral health issues receiving no care due to provider scarcity and geographic distribution.
“However, resources and infrastructure to treat UAU in Mozambique are limited; 75–90% of people with behavioral health issues receive no care because of provider scarcity and geographic distribution (Demyttenaere et al., 2004; dos Santos et al., 2016; Dua et al., 2011).”
From Mobile technology and task shifting to improve access to alcohol treatment services in Mozambique (2022) · cites this paper as Demyttenaere et al., 2004
The most common barriers for mental health care utilization include low perceived needs, stigma and discrimination associated with mental illness, inability to afford the treatment cost, poor identification and referral system, and shortage of human resources.
“The most common barriers for mental health care utilization include low perceived needs, stigma and discrimination associated with mental illness, inability to afford the treatment cost, poor identification and referral system, and shortage of human resources [4–10].”
In low- and middle-income countries, the majority (76%-85%) of people suffering from mental disorders receive no treatment at all.
“It is estimated that in low- and middle-income countries, the majority (76%-85%) of people suffering from mental disorders receive no treatment at all [1].”
From Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials (2021) · cites this paper as [1]
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Global Mental Health: A New Global Health Field Comes of Age
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Reducing the treatment gap for mental disorders: a WPA survey
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Epidemiology of substance use disorders
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- Authors
- The WHO World Mental Health Survey Consortium
- Affiliations
- Harvard University (US)
- Corresponding author
- The WHO World Mental Health Survey Consortium
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2004-06-02
- Volume
- 291
- Issue
- 21
- Pages
- 2581
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2075107167
- Semantic Scholar
- 68981d738295a4abf860df5bcab080a96f2d93ee
- Cited by
- 3,448
- References
- 55
- Citations by year
- 2026: 52 · 2025: 86 · 2024: 121 · 2023: 140 · 2022: 160 · 2021: 196 · 2020: 206 · 2019: 142 · 2018: 178 · 2017: 212 · 2016: 203 · 2015: 183 · 2014: 202 · 2013: 157 · 2012: 171
- FWCI
- 185.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Robert Wood Johnson Foundation (044708, Grant 044708)
- John D. and Catherine T. MacArthur Foundation (R01 DA016558)
- John W. Alden Trust
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- World Health Organization
- Michigan State University
- European Commission (QLG5–1999-01042)
- Generalitat de Catalunya (01042)
- Chinese University of Hong Kong
- Regione Piemonte (00/0028)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04)
- Substance Abuse and Mental Health Services Administration
- College of Engineering, Michigan State University
- Pfizer Foundation (R01-DA016558)
- Pan American Health Organization
- Instituto de Salud Carlos III (FIS 00/0028)
- National Institute of Mental Health (R01 MH069864-01, U01-MH-60220, R13 MH066849-02, MH60220)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- mental illness, prevalence, disorder severity, community-dwelling adults, DSM-IV disorders
- MeSH terms
- Adult, Mental Disorders, Developing Countries, Health Surveys, Humans, Mental Health Services, Severity of Illness Index, Global Health, Prevalence, Developed Countries, Needs Assessment, Diagnostic and Statistical Manual of Mental Disorders
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