title: High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country.
abstract: BACKGROUND
  The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth.
  
  
  OBJECTIVE
  To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting.
  
  
  METHODS
  We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments.
  
  
  RESULTS
  The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year.
  
  
  CONCLUSIONS
  Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: Eddy
authors.initials: E
authors.lastname: Eustache
authors.affiliation: 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Gerbasi
authors.affiliation: 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith Fawzi
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: J Reginald
authors.initials: JR
authors.lastname: Fils-Aimé
authors.affiliation: 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.|3 Department of Psychiatry, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Severe
authors.affiliation: 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.|4 Partners In Health, Boston, MA, USA.|5 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Giuseppe J
authors.initials: GJ
authors.lastname: Raviola
authors.affiliation: 6 Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Rupinder
authors.initials: R
authors.lastname: Legha
authors.affiliation: 7 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Darghouth
authors.affiliation: 8 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grelotti
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Thérosmé
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: Ermaze L
authors.initials: EL
authors.lastname: Pierre
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: Emmeline
authors.initials: E
authors.lastname: Affricot
authors.affiliation: 1 Mental Health and Psychosocial Services, Zanmi Lasante, Mirebalais, Haiti.
authors.forename: Yoldie
authors.initials: Y
authors.lastname: Alcindor
authors.affiliation: 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.|7 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D008603:Mental Health; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011203:Poverty; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D012574:Schools; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult
keywords: Haiti; Mental health treatment gap; low-income countries; mental health burden; youth