title: Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.
abstract: BACKGROUND
  Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment.
  
  
  METHODS
  Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services.
  
  
  RESULTS
  The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less.
  
  
  CONCLUSIONS
  Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, Rockville, MD, USA. wangphi@mail.nih.gov
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Angermeyer
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Viviane
authors.initials: V
authors.lastname: Kovess
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lane
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.forename: Daphna
authors.initials: D
authors.lastname: Levinson
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ono
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: José
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.forename: J Elisabeth
authors.initials: JE
authors.lastname: Wells
mesh_terms: D001007:Anxiety / Q000628:therapy; D006306:Health Surveys; D006801:Humans; D007182:Income; D016015:Logistic Models; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D014944:World Health Organization