Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

• Published in: Depression and anxiety Vol. 35; no. 3; pp. 195 - 208
• Main Authors: Alonso, Jordi, Liu, Zhaorui, Evans‐Lacko, Sara, Sadikova, Ekaterina, Sampson, Nancy, Chatterji, Somnath, Abdulmalik, Jibril, Aguilar‐Gaxiola, Sergio, Al‐Hamzawi, Ali, Andrade, Laura H., Bruffaerts, Ronny, Cardoso, Graça, Cia, Alfredo, Florescu, Silvia, Girolamo, Giovanni, Gureje, Oye, Haro, Josep M., He, Yanling, Jonge, Peter, Karam, Elie G., Kawakami, Norito, Kovess‐Masfety, Viviane, Lee, Sing, Levinson, Daphna, Medina‐Mora, Maria Elena, Navarro‐Mateu, Fernando, Pennell, Beth‐Ellen, Piazza, Marina, Posada‐Villa, José, ten Have, Margreet, Zarkov, Zahari, Kessler, Ronald C., Thornicroft, Graham
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2018; Wiley
• Subjects: Adequate treatment; Adolescent; Adult; Aged; Aged, 80 and over; Anxiety disorders; Anxiety Disorders - therapy; Female; Global Health - statistics & numerical data; Health Care Surveys - statistics & numerical data; Health services; Humans; Life Sciences; Male; Mental disorders; Mental health; Mental Health - statistics & numerical data; Middle Aged; Nerves; Patient Acceptance of Health Care - statistics & numerical data; Perceived need for care; Post traumatic stress disorder; Psychotherapy; Quality of Health Care - statistics & numerical data; Santé publique et épidémiologie; Surveys; Young Adult; surveys; perceived need for care; anxiety disorders; health services; adequate treatment; Surveys; Perceived need for care; Adequate treatment; Anxiety disorders; Health services
• ISSN: 1091-4269; 1520-6394; 1520-6394
• DOI: 10.1002/da.22711

Background Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12‐month DSM‐IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Methods Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM‐IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM‐IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM‐5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for “problems with emotions, nerves, mental health, or use of alcohol or drugs.” Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Results Of 51,547 respondents (response = 71.3%), 9.8% had a 12‐month DSM‐IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12‐month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Conclusions Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.