Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.
BACKGROUND
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.


METHODS
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.


METHODS
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.
Demyttenaere
Koen
K
Bruffaerts
Ronny
R
Posada-Villa
Jose
J
Gasquet
Isabelle
I
Kovess
Viviane
V
Lepine
Jean Pierre
JP
Angermeyer
Matthias C
MC
Bernert
Sebastian
S
de Girolamo
Giovanni
G
Morosini
Pierluigi
P
Polidori
Gabriella
G
Kikkawa
Takehiko
T
Kawakami
Norito
N
Ono
Yutaka
Y
Takeshima
Tadashi
T
Uda
Hidenori
H
Karam
Elie G
EG
Fayyad
John A
JA
Karam
Aimee N
AN
Mneimneh
Zeina N
ZN
Medina-Mora
Maria Elena
ME
Borges
Guilherme
G
Lara
Carmen
C
de Graaf
Ron
R
Ormel
Johan
J
Gureje
Oye
O
Shen
Yucun
Y
Huang
Yueqin
Y
Zhang
Mingyuan
M
Alonso
Jordi
J
Haro
Josep Maria
JM
Vilagut
Gemma
G
Bromet
Evelyn J
EJ
Gluzman
Semyon
S
Webb
Charles
C
Kessler
Ronald C
RC
Merikangas
Kathleen R
KR
Anthony
James C
JC
Von Korff
Michael R
MR
Wang
Philip S
PS
Brugha
Traolach S
TS
Aguilar-Gaxiola
Sergio
S
Lee
Sing
S
Heeringa
Steven
S
Pennell
Beth-Ellen
BE
Zaslavsky
Alan M
AM
Ustun
T Bedirhan
TB
Chatterji
Somnath
S
D000328:Adult; D019049:Developed Countries; D003906:Developing Countries; D039721:Diagnostic and Statistical Manual of Mental Disorders; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services; D020380:Needs Assessment; D015995:Prevalence; D012720:Severity of Illness Index