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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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“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].”
From Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal (2021) · cites this paper as [4]
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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]
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“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
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“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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“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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“Background Despite the high prevalence of mental disorders in low- and middle-income countries (LMICs), international health surveys show that only 80% of those with serious mental disorders receive any treatment [1].”
BackgroundEffect of Age, Weight, and CYP2C19 Genotype on Escitalopram Exposure
Jin, Y., Pollock, B. G., Frank, E., Cassano, G. B., Rucci, P., Müller, D. J., Kennedy, J. L., Forgione, R. N., Kirshner, M. A., Kepple, G., et al. (2009) · The Journal of Clinical Pharmacology · doi:10.1177/0091270009337946 · Cited by 71
Lopez‐Quintero, C., & Neumark, Y. D. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.12.011 · Cited by 78
Forgiveness and Alcohol Problems Among People Entering Substance Abuse Treatment
Webb, J. R., Robinson, E. A., Brower, K. J., & Zucker, R. A. (2006) · Journal of Addictive Diseases · doi:10.1300/j069v25n03_08 · Cited by 70
Prevalence and geographic disparity of depressive symptoms among middle-aged and elderly in China
Pan, A., Franco, O. H., Wang, Y., Yu, Z., Ye, X.-W., & Lin, X. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.05.003 · Cited by 70
Singh, O. (2018) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_458_18 · Cited by 70
“According to the WHO study, the treatment gap (the number of people with disease who are not in treatment) of mental disorders in developing countries was 76%–85%.[1] According to the recently conducted National Mental Health Survey (NMHS), the treatment gap of any mental disorder in India was reported to be as high a…”
MethodLongitudinal measurement invariance of the Beck Scale for Suicide Ideation
Beurs, D. P. D., Fokkema, M., de Groot, M. H., de Keijser, J., & Kerkhof, A. J. F. M. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.075 · Cited by 69
Marital Status and Mental Health
Williams, K., Frech, A., & Carlson, D. L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.020 · Cited by 70
Jacobs, Y., Myers, B., van der Westhuizen, C., Brooke-Sumner, C., & Sorsdahl, K. (2021) · Community Mental Health Journal · doi:10.1007/s10597-020-00734-0 · Cited by 65
Glannon, W. (2005) · Bioethics · doi:10.1111/j.1467-8519.2006.00474.x · Cited by 68
Mapping the effectiveness of integrating mental health in HIV programs: a scoping review
Conteh, N. K., Latona, A., & Mahomed, O. H. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09359-x · Cited by 81
Khalily, M. T. (2011) · International Journal of Integrated Care · doi:10.5334/ijic.662 · Cited by 70
Receiving treatment for common mental disorders
Verhaak, P. F. M., Prins, M., Spreeuwenberg, P. M. M., Draisma, S., van Balkom, T. J. L. M., Bensing, J. M., Laurant, M. G. H., van Marwijk, H., van der Meer, K., & Penninx, B. W. J. H. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.09.011 · Cited by 68
Applying the Tripartite Model of Anxiety and Depression to Cigarette Smoking: An Integrative Review
Ameringer, K. J., & Leventhal, A. M. (2010) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq174 · Cited by 68
Elovainio, M. J., Linna, A., Virtanen, M., Oksanen, T., Mika Kivimaki, B., Pentti, J., & Vahtera, J. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.05.008 · Cited by 75
Mitchell, A. J., Rao, S., & Vaze, A. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x556227 · Cited by 73
School Intervention to Improve Mental Health of Students in Santiago, Chile
Araya, R., Rosemarie Fritsch, M., Spears, M. R., Rojas, G., Martínez, V., Barroilhet, S. A., Vöhringer, P. A., Gunnell, D., Stallard, P. N., Viviana Guajardo, T., et al. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.2361 · Cited by 68
Tsuchiya, M., Kawakami, N., Ono, Y., Nakane, Y., Nakamura, Y., Fukao, A., Tachimori, H., Iwata, N., Uda, H., Nakane, H., et al. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.10.014 · Cited by 68
Anxiety and depression in adolescents with CF and their caregivers
Besier, T., & Goldbeck, L. (2011) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2011.06.012 · Cited by 75
Determinants of access to health care for depression in 49 countries: A multilevel analysis
Araya, R., Pedro Zitko, M., Markkula, N., Rai, D., & Jones, K. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.092 · Cited by 72
Tanaka, C., Tuliao, M. T., Tanaka, E., Yamashita, T., & Matsuo, H. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1902-9 · Cited by 68
“Our findings might better reflect the reality in LMIC settings, where it is estimated that more than 70% of PMHP receive no treatment for their mental health conditions [52].”
BackgroundLongitudinal assessment of an anti-stigma campaign related to common mental disorders in rural India
Maulik, P. K., Devarapalli, S., Kallakuri, S., Tripathi, A. P., Koschorke, M., & Thornicroft, G. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.190 · Cited by 67
Use of health services for major depressive and anxiety disorders in Finland
Hämäläinen, J., Isometsä, E., Sihvo, S., Pirkola, S., & Kiviruusu, O. (2008) · Depression and Anxiety · doi:10.1002/da.20256 · Cited by 64
Countering the stigmatisation and discrimination of people with mental health problems in Europe
McDaid, D. (2008) · Cited by 66
Antunes, A., Frasquilho, D., Lopes, S. A., Neto, D., Silva, M., Cardoso, G., & Caldas‐de‐Almeida, J. M. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2017.12.004 · Cited by 67
The psychosis treatment gap and its consequences in rural Ethiopia
Fekadu, A., Medhin, G., Lund, C., DeSilva, M., Selamu, M., Alem, A., Asher, L., Birhane, R., Patel, V., Hailemariam, M., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2281-6 · Cited by 67
Lincoln, K. D., Taylor, R. J., Bullard, K. M., Chatters, L. M., Woodward, A. T., Himle, J. A., & Jackson, J. S. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2383 · Cited by 67
Community building and mental health in mid-life and older life: Evidence from China
Shen, Y. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.12.023 · Cited by 67
Butnorienė, J., Bunevičius, A., Saudargienė, A., Nemeroff, C. B., Norkus, A., Ciceniene, V., & Bunevičius, R. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.04.122 · Cited by 68
EPIDEMIOLOGY OF HEAVY ALCOHOL USE IN UKRAINE: FINDINGS FROM THE WORLD MENTAL HEALTH SURVEY
Webb, C. P. M., Bromet, E. J., Gluzman, S. F., Tintle, N., Schwartz, J. E., Kostyuchenko, S., & Havenaar, J. M. (2005) · Alcohol and Alcoholism · doi:10.1093/alcalc/agh152 · Cited by 67
The China Mental Health Survey (CMHS): I. background, aims and measures
Huang, Y., Liu, Z., Hong, W., Guan, X., Chen, H., Ma, C., Li, Q., Yan, J., Yu, Y., Kou, C., et al. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1270-z · Cited by 67
“4% [6].”
Ethnic density, urbanicity and psychosis risk for migrant groups – A population cohort study
Schofield, P., Thygesen, M., Das‐Munshi, J., Bécares, L., Cantor‐Graae, E., Pedersen, C. B., & Agerbo, E. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.03.032 · Cited by 67
“Financial factors are thus less likely to influence pathways to care in Denmark compared to many other nations (Demyttenaere et al., 2004).”
Background
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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