TY - JOUR
T1 - Toward measuring effective treatment coverage
T2 - critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder
AU - Vigo, Daniel
AU - Haro, Josep Maria
AU - Hwang, Irving
AU - Aguilar-Gaxiola, Sergio
AU - Alonso, Jordi
AU - Borges, Guilherme
AU - Bruffaerts, Ronny
AU - Caldas-de-Almeida, Jose Miguel
AU - de Girolamo, Giovanni
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Karam, Elie
AU - Karam, Georges
AU - Kovess-Masfety, Viviane
AU - Lee, Sing
AU - Navarro-Mateu, Fernando
AU - Ojagbemi, Akin
AU - Posada-Villa, Jose
AU - Sampson, Nancy A
AU - Scott, Kate
AU - Stagnaro, Juan Carlos
AU - Ten Have, Margreet
AU - Viana, Maria Carmen
AU - Wu, Chi-Shin
AU - Chatterji, Somnath
AU - Cuijpers, Pim
AU - Thornicroft, Graham
AU - Kessler, Ronald C
PY - 2020/10/20
Y1 - 2020/10/20
N2 - 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.
AB - 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.
U2 - 10.1017/S0033291720003797
DO - 10.1017/S0033291720003797
M3 - Article
C2 - 33077023
SP - 1
EP - 11
JO - Psychological Medicine
JF - Psychological Medicine
SN - 0033-2917
ER -
