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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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“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]”
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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
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“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 the citing paper
“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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Coppens, E., Audenhove, C. V., Scheerder, G., Arensman, E., Coffey, C., Costa, S., Koburger, N., Gottlebe, K., Gusmão, R. M., O’Connor, R. C., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.04.013 · Cited by 178
“National surveys in Europe indicate that less than half of the people with major depression receive any formal professional help (Demyttenaere et al., 2004; Fernandez et al., 2007).”
BackgroundImpact of early adversity on glucocorticoid regulation and later mental disorders
Strüber, N., Strüber, D., & Roth, G. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.10.015 · Cited by 173
Spanhel, K., Balci, S., Feldhahn, F., Bengel, J., Baumeister, H., & Sander, L. B. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00498-1 · Cited by 178
Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China
Lee, S., Fung, S. C., Tsang, A., Liu, Z. R., Huang, Y., He, Y. L., Zhang, M. Y., Shen, Y., Nock, M. K., & Kessler, R. C. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01064.x · Cited by 177
Nandi, A., Beard, J., & Galea, S. (2009) · BMC Psychiatry · doi:10.1186/1471-244x-9-31 · Cited by 192
Roberts, B., Makhashvili, N., Javakhishvili, J., Karachevskyy, A., Kharchenko, N., Shpiker, M., & Richardson, E. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796017000385 · Cited by 177
“…rest of the Ukrainian population as the only other study on the treatment gap in Ukraine (from the 2001–2003 World Mental Health Survey) used a different methodology and definition, which followed narrower criteria, which led to an even higher treatment gap of around 83% (Demyttenaere et al. 2004).”
BackgroundMethodKeeley, J. W., Reed, G. M., Roberts, M. C., Evans, S. C., Medina-Mora, M. E., Robles, R., Rebello, T., Sharan, P., Gureje, O., First, M. B., et al. (2016) · American Psychologist · doi:10.1037/a0039972 · Cited by 173
Shidhaye, R. R., & Patel, V. (2010) · International Journal of Epidemiology · doi:10.1093/ije/dyq179 · Cited by 176
Arvind, B. A., Gururaj, G., Loganathan, S., Amudhan, S., Varghese, M., Benegal, V., Rao, G. N., Kokane, A. M., Chavan, B. S., Dalal, P., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027250 · Cited by 188
Magán, I., Sanz, J., & García-Vera, M. P. (2008) · The Spanish Journal of Psychology · doi:10.1017/s1138741600004637 · Cited by 157
Anxiety and Depression: Linkages with Viral Diseases
Coughlin, S. S. (2012) · Public health reviews · doi:10.1007/bf03391675 · Cited by 174
“Estimates of the prevalence of these anxiety and mood disorders are available from the National Comorbidity Survey Replication and the World Health Organization World Mental Health Surveys.12,13 As noted in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, 4th Edition, Text…”
MethodCarlson, E. J., Saarikallio, S. H., Toiviainen, P., Bogert, B., Kliuchko, M., & Brattico, E. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00466 · Cited by 192
“The World Health Organization (WHO) has reported that up to 50% of those with psychiatric illness worldwide, including the perniciously common (and commonly comorbid) mood and anxiety disorders, do not receive adequate treatment (Demyttenaere et al., 2004), leaving a substantial gap that could be partially filled by t…”
BackgroundEpidemiology of psychiatric and alcohol disorders in Ukraine
Bromet, E. J., Gluzman, S. F., Paniotto, V., Webb, C. P. M., Tintle, N., Zakhozha, V., Havenaar, J. M., Gutkovich, Z. A., Kostyuchenko, S., & Schwartz, J. E. (2005) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0927-9 · Cited by 171
Depression in Older People: Visual Impairment and Subjective Ratings of Health
Hayman, K., Kerse, N. M., Grow, S. J. L., Wouldes, T. A., Robertson, M. C., & Campbell, A. J. (2007) · Optometry and Vision Science · doi:10.1097/opx.0b013e318157a6b1 · Cited by 170
Recent trends in the incidence of recorded depression in primary care
Rait, G., Walters, K., Griffin, M., Buszewicz, M., Petersen, I., & Nazareth, I. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.058636 · Cited by 168
COVID-19 vaccination for people with severe mental illness: why, what, and how?
Mazereel, V., Assche, K. V., Detraux, J., & Binder, M. D. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30564-2 · Cited by 181
Yang, Y., Liu, L., Wang, Y., Wu, H. L., Yang, X., Wang, J., & Wang, L. (2013) · BMC Cancer · doi:10.1186/1471-2407-13-393 · Cited by 172
“Second explanation might be that most of the included studies of these reviews are from developed countries which have lower prevalence of mental health problems as compared to developing countries like China [69].”
ResultMeta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015
Guo, X., Meng, Z., Huang, G., Fan, J., Zhou, W., Ling, W., Jiang, J., Long, J., & Su, L. (2016) · Scientific Reports · doi:10.1038/srep28033 · Cited by 169
“The comparative results were consistent with previous studies that suggested that the prevalence of ADs was lower in Asian countries and in less developed countries 13,40,42 .”
InfluentialGearing, R. E., Schwalbe, C. S., MacKenzie, M. J., Brewer, K. B., Ibrahim, R. W., Olimat, H. S., Al-Makhamreh, S. S., Mian, I., & Al-Krenawi, A. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764012452349 · Cited by 167
Alcohol use disorders in EU countries and Norway: An overview of the epidemiology
Rehm, J. T., Room, R., van den Brink, W., & Jacobi, F. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.005 · Cited by 169
Melis, G., Gelormino, E., Marra, G., Ferracin, E., & Costa, G. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph121114898 · Cited by 167
“Depression is severely underdiagnosed and undertreated, even in developed countries [56,57].”
BackgroundLucas, M., Mirzaei, F., O’Reilly, É. J., Pan, A., Willett, W. C., Kawachi, I. I., Koenen, K. C., & Ascherio, A. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.011817 · Cited by 169
Are patients with COPD psychologically distressed?
Wagena, E. J., Arrindell, W. A., Wouters, E. F. �., & van Schayck, O. C. P. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00010604 · Cited by 163
Kämpfen, F., Kohler, I. V., Ciancio, A., Bruine de Bruin, W., Maurer, J., & Kohler, H.-P. (2020) · PLOS ONE · doi:10.1371/journal.pone.0241895 · Cited by 173
Reynders, A., Kerkhof, A. J. F. M., Molenberghs, G., & Audenhove, C. V. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0745-4 · Cited by 164
“many barriers for seeking help, resulting in high rates of unmet need [1, 2].”
BackgroundBenjet, C. L., Borges, G. L. G., Medina‐Mora, M. E., Zambrano, J., & Aguilar‐Gaxiola, S. (2008) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.01962.x · Cited by 175
Duncan, A. E., Ziobrowski, H. N., & Nicol, G. E. (2017) · European Eating Disorders Review · doi:10.1002/erv.2503 · Cited by 164
“Similarly, Kessler et al. (2013) also found that obesity was associated with lifetime BN and BED (they did not examine any binge eating or AN) using data from the World Mental Health Surveys (Kessler et al., 2013), which include the NSC-R (The WHOWorld Mental Health Survey Consortium, 2004).”
MethodTrollor, J. N., Anderson, T. M., Sachdev, P. S., Brodaty, H., & Andrews, G. (2007) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3180590ba9 · Cited by 161
Ae-Ngibise, K. A., Doku, V. C. K., Asante, K. P., & Owusu‐Agyei, S. (2015) · Global Health Action · doi:10.3402/gha.v8.26957 · Cited by 182
Strauss, J. S., & Thomas, D. (2008) · eScholarship (California Digital Library) · Cited by 162
Mental health literacy: focus on developing countries
Ganasen, K. A., Parker, S., Hugo, C., Stein, D. J., Emsley, R. A., & Seedat, S. (2008) · African Journal of Psychiatry · doi:10.4314/ajpsy.v11i1.30251 · Cited by 162
Risk of Depression and Anxiety in Adults With Cerebral Palsy
Smith, K. J., Peterson, M. D., O'Connell, N. E., Victor, C. R., Liverani, S., Anokye, N., & Ryan, J. M. (2018) · JAMA Neurology · doi:10.1001/jamaneurol.2018.4147 · Cited by 162
Hof, E. V., Cuijpers, P., & Stein, D. J. (2009) · CNS Spectrums · doi:10.1017/s1092852900027279 · Cited by 156
Prevalence of common mental disorders in Italy
de Girolamo, G., Polidori, G., Morosini, P., Scarpino, V., Reda, V., Serra, G., Mazzi, F., Alonso, J., Vilagut, G., Visonà, G., et al. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0097-4 · Cited by 159
Mojtabai, R., Fochtmann, L. J., Chang, S.-W., Kotov, R., Craig, T., & Bromet, E. J. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp045 · Cited by 167
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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