Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative.
Por:
Fernández D, Vigo D, Sampson NA, Hwang I, Aguilar-Gaxiola S, Al-Hamzawi AO, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, de Jonge P, Florescu S, Gureje O, Hinkov H, Hu C, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Ojagbemi A, O'Neill S, Piazza M, Posada-Villa J, Rapsey C, Williams DR, Xavier M, Ziv Y, Kessler RC and Haro JM
Publicada:
1 sep 2021
Ahead of Print:
28 abr 2020
Categoría:
Applied psychology
Resumen:
BACKGROUND: There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. METHODS: Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. RESULTS: Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. CONCLUSIONS: Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Filiaciones:
:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia-BarcelonaTech, Barcelona, Spain
Vigo D:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
Sampson NA:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Hwang I:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Aguilar-Gaxiola S:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
Al-Hamzawi AO:
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
Alonso J:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
Pompeu Fabra University (UPF), Barcelona, Spain
Andrade LH:
Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Bromet EJ:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
de Girolamo G:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
de Jonge P:
Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands
Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
Florescu S:
National School of Public Health, Management and Development, Bucharest, Romania
Gureje O:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Hinkov H:
National Center of Public Health and Analyses, Sofia, Bulgaria
Hu C:
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
Karam EG:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Karam G:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Kawakami N:
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
Kiejna A:
Wroclaw Medical University
University of Lower Silesia, Wroclaw, Poland
Kovess-Masfety V:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Medina-Mora ME:
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Navarro-Mateu F:
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
Ojagbemi A:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
O'Neill S:
School of Psychology, Ulster University, Londonderry, United Kingdom
Piazza M:
Universidad Cayetano Heredia, Lima, Peru
Posada-Villa J:
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Rapsey C:
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Williams DR:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Xavier M:
NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal and
Ziv Y:
Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Haro JM:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
Green Submitted, Green Published, Green Accepted
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