Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
Por:
Vigo D, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, Borges G, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Karam E, Karam G, Kovess-Masfety V, Lee S, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson NA, Scott K, Stagnaro JC, Ten Have M, Viana MC, Wu CS, Chatterji S, Cuijpers P, Thornicroft G and Kessler RC
Publicada:
1 jul 2022
Ahead of Print:
20 oct 2020
Resumen:
BACKGROUND: Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. METHODS: Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. RESULTS: MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. CONCLUSIONS: Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
Filiaciones:
Vigo D:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Haro JM:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
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
Alonso J:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Pompeu Fabra University (UPF), Barcelona, Spain
Borges G:
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Bruffaerts R:
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
Caldas-de-Almeida JM:
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
de Girolamo G:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Florescu S:
National School of Public Health, Management and Development, Bucharest, Romania
Gureje O:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Karam E:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Karam G:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Kovess-Masfety V:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Lee S:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
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 of Ibadan, Nigeria
Posada-Villa J:
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Sampson NA:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Scott K:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Stagnaro JC:
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
Ten Have M:
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Viana MC:
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
Wu CS:
Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
Chatterji S:
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
Cuijpers P:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
The Netherlands & EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
Thornicroft G:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Green Accepted
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