title: Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries.
abstract: OBJECTIVE
  To outline mental health service accessibility, estimate the treatment gap and describe service utilization for people with schizophrenic disorders in 50 low- and middle-income countries.
  
  
  METHODS
  The World Health Organization Assessment Instrument for Mental Health Systems was used to assess the accessibility of mental health services for schizophrenic disorders and their utilization. The treatment gap measurement was based on the number of cases treated per 100,000 persons with schizophrenic disorders, and it was compared with subregional estimates based on the Global burden of disease 2004 update report. Multivariate analysis using backward step-wise regression was performed to assess predictors of accessibility, treatment gap and service utilization.
  
  
  RESULTS
  The median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100,000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap.
  
  
  CONCLUSIONS
  The treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries.
authors.affiliation: Mental Health Department, Lecco General Hospital, via dell’Eremo 9/11, 23900 Lecco, Italy. antoniolora@virgilio.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Lora
authors.forename: Robert
authors.initials: R
authors.lastname: Kohn
authors.forename: Itzhak
authors.initials: I
authors.lastname: Levav
authors.forename: Ryan
authors.initials: R
authors.lastname: McBain
authors.forename: Jodi
authors.initials: J
authors.lastname: Morris
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D015995:Prevalence; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology; D014944:World Health Organization