Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys.
Por:
Degenhardt L, Glantz M, Evans-Lacko S, Sadikova E, Sampson N, Thornicroft G, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Helena Andrade L, Bruffaerts R, Bunting B, Bromet EJ, Miguel Caldas de Almeida J, de Girolamo G, Florescu S, Gureje O, Haro JM, Huang Y, Karam A, Karam EG, Kiejna A, Lee S, Lepine JP, Levinson D, Elena Medina-Mora M, Nakamura Y, Navarro-Mateu F, Pennell BE, Posada-Villa J, Scott K, Stein DJ, Ten Have M, Torres Y, Zarkov Z, Chatterji S, Kessler RC and World Health Organization's World Mental Health Surveys collaborators
Publicada:
1 oct 2017
Resumen:
Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.
Filiaciones:
Degenhardt L:
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Glantz M:
Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
Evans-Lacko S:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Sadikova E:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Sampson N:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Thornicroft G:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Aguilar-Gaxiola S:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
Al-Hamzawi A:
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
Alonso J:
Health Services Research Unit, Hospital del Mar Medical Research Institute
Pompeu Fabra University
and CIBER en Epidemiología y Salud Pública, Barcelona, Spain
Helena Andrade L:
Section of Psychiatric Epidemiology, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
Bruffaerts R:
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
Bunting B:
School of Psychology, Ulster University, Londonderry, UK
Bromet EJ:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
Miguel Caldas de Almeida J:
Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
de Girolamo G:
IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Florescu S:
National School of Public Health, Management and Professional Development, Bucharest, Romania
Gureje O:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Haro JM:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
Huang Y:
Institute of Mental Health, Peking University, Beijing, China
Karam A:
Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
Karam EG:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon
Kiejna A:
Wroclaw Medical University, University of Lower Silesia, Wroclaw, Poland
Lee S:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Lepine JP:
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, Paris Diderot and Paris Descartes Universities, Paris, France
Levinson D:
Mental Health Services, Ministry of Health, Israel
Elena Medina-Mora M:
National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
Nakamura Y:
Department of Public Health, Jichi Medical University, Shimotsuke, Japan
Navarro-Mateu F:
Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Murcia, Spain
Pennell BE:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
Posada-Villa J:
Colegio Mayor de Cundinamarca University, Bogota, Colombia
Scott K:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Stein DJ:
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Ten Have M:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Torres Y:
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
Zarkov Z:
Directorate for Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
Chatterji S:
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Open Access
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