Disability and treatment of specific mental and physical disorders across the world
Open accessAbstract
Background: Advocates of expanded mental health treatment assert that mental disorders are as disabling as physical disorders, but little evidence supports this assertion. Aims: To establish the disability and treatment of specific mental and physical disorders in high-income and low- and middle-income countries. Method: Community epidemiological surveys were administered in 15 countries through the World Health Organization World Mental Health (WMH) Survey Initiative. Results: Respondents in both high-income and low- and middle-income countries attributed higher disability to mental disorders than to the commonly occurring physical disorders included in the surveys. This pattern held for all disorders and also for treated disorders. Disaggregation showed that the higher disability of mental than physical disorders was limited to disability in social and personal role functioning, whereas disability in productive role functioning was generally comparable for mental and physical disorders. Conclusions: Despite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.
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The treatment gap is larger for people with low SES and for those in low-income countries, even after adjustment for disorder severity.
“This gap is even greater for people with low socio-economic status (SES) and those living in low-income countries (Steele et al. 2007; Ormel et al. 2008) even adjusting for disorder severity (Mojtabai, 2010; Andrade et al. 2014).”
From Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys (2018) · cites this paper as Ormel et al. 2008
The ‘Self-reported disorder prevalence and treatment’ section (page unavailable) reports a larger mental-versus-physical treatment gap in low- and middle-income countries than in high-income countries, including among severely disabling disorders. Our copy does not establish a larger gap for people with low SES. The citing sentence attributes the severity-adjustment clause to other citations, not specifically to Ormel et al.; this paper reports comparisons by severity rather than an adjusted SES finding. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMusculoskeletal disorders and major depressive episode are associated with the highest levels of disability at the individual level among commonly occurring disorders; major depressive disorder and bipolar disorder are the mental disorders most often rated severely impairing in both developed and developing countries; none of the physical disorders considered had impairment levels as high as major
“MDE was included in a number of these studies and the results typically showed that musculoskeletal disorders and MDE were associated with the highest levels of disability at the individual level among all commonly occurring disorders assessed. The most compelling study of this sort outside the US was based on fifteen national surveys carried out as part of the WMH surveys.82 Disorder-specific dis”
From The Costs of Depression (2012) · cites this paper as [81]
Even if depression is more a consequence than a cause of chronic physical disorders, as it appears to be for some disorders, comorbid depression is often associated with a worse course of the physical disorder.
“Second, even if depression is more a consequence than a cause of chronic physical disorders, as it appears to be for some disorders, comorbid depression is often associated with a worse course of the physical disorder. 187-190”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [188]
Mental disorders are a significant contributor to disability in the general population.
“Mental disorders are a significant contributor to disability in the general population (Ormel et al., 2008; Verger, Guagliardo, Gilbert, Rouillon, & Kovess-Masfetty, 2010).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Ormel et al., 2008
Severity of health-related role impairment during the past 12 months was assessed using an adapted version of the Sheehan Disability Scale.
“Severity of health-related role impairment during the past 12 months was assessed using an adapted version of the Sheehan Disability Scale (Leon, Olfson, Portera, Farber, & Sheehan, 1997; Ormel et al., 2008).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Ormel et al., 2008
Our results are in line with studies of adults in the general population, where individuals with mental disorders reported severe role impairment more frequently than those with physical conditions, due to a higher association with social and personal relationships.
“Our results are also in line with studies of adults in the general population, where individuals with mental disorders reported severe role impairment more frequently than those with physical conditions, due to a higher association with social and personal relationships (Ormel et al., 2008).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Ormel et al., 2008
The combination of a high prevalence and high impact makes major depressive episode and GAD a major source of role impairment among first-year university students.
“The combination of a high prevalence and high impact makes them a major source of role impairment among first year university students (Ormel et al., 2008; Verger et al., 2010).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Ormel et al., 2008
Bias from the modified SDS should be small given that impairment of mental disorders as measured by the SDS tends to be higher than that of physical conditions.
“But bias should be small given that impairment of mental disorders as measured by the SDS tends to be higher than that of physical conditions (Ormel et al., 2008).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Ormel et al., 2008
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- Authors
- Ormel, J., Petukhova, M., Chatterji, S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Bromet, E. J., Burger, H., Demyttenaere, K., de Girolamo, G., Haro, J. M., Hwang, I., Karam, E., Kawakami, N., Lépine, J. P., Medina-Mora, M. E., Posada-Villa, J., Sampson, N., Scott, K., Üstün, T. B., Von Korff, M., Williams, D. R., Zhang, M., & Kessler, R. C.
- Affiliations
- University Medical Center Groningen (NL)
- Harvard University (US)
- World Health Organization (CH)
- Leipzig University (DE)
- Stony Brook University (US)
- Universitair Ziekenhuis Leuven (BE)
- Saint George Hospital (LB)
- The University of Tokyo (JP)
- Universidad Colegio Mayor de Cundinamarca (CO)
- University of Otago (NZ)
- University of Michigan (US)
- Shanghai Mental Health Center (CN)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2008-05
- Volume
- 192
- Issue
- 5
- Pages
- 368-375
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC2681238
- OpenAlex
- W2171668194
- Cited by
- 389
- References
- 40
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 14 · 2023: 18 · 2022: 19 · 2021: 28 · 2020: 17 · 2019: 25 · 2018: 30 · 2017: 22 · 2016: 18 · 2015: 20 · 2014: 31 · 2013: 29 · 2012: 24
- FWCI
- 34.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Robert Wood Johnson Foundation (044780, Grant 044780)
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust (R01-MH069864, R01-MH070884, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- World Health Organization
- University of Michigan
- European Commission (1999-01042, QLG5–1999-01042, SANCO2004123, 2004123)
- Generalitat de Catalunya (01042)
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Regione Piemonte (00/0028)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- U.S. Public Health Service (R01 069864, HHSN 271200700030C)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849)
- Pan American Health Organization
- Instituto de Salud Carlos III (FIS 00/0028)
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, MH61905, U01-MH-60220, R01MH061905, R01MH059575, MH60220, MH070884, HHSN271200700030C, MH069864, U13MH066849, MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558, U01-MH60220)
- Fogarty International Center (FIRCA R01-TW006481, R01-TW006481, R03 TW0006481, R03TW006481)
- Cilag
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- disability, mental illness, physical disorders, psychotherapy, undertreatment, role functioning, social functioning, low- and middle-income countries, high-income countries, World Mental Health Survey Initiative
- MeSH terms
- Activities of Daily Living, Mental Disorders, Chronic Disease, Cross-Cultural Comparison, Epidemiologic Methods, Health Services Accessibility, Health Status, Humans, Global Health, Cost of Illness
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