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. 2018 Jul;48(9):1560-1571.
doi: 10.1017/S0033291717003336. Epub 2017 Nov 27.

Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys

S Evans-Lacko  1 , S Aguilar-Gaxiola  2 , A Al-Hamzawi  3 , J Alonso  4 , C Benjet  5 , R Bruffaerts  6 , W T Chiu  7 , S Florescu  8 , G de Girolamo  9 , O Gureje  10 , J M Haro  11 , Y He  12 , C Hu  13 , E G Karam  14 , N Kawakami  15 , S Lee  16 , C Lund  1 , V Kovess-Masfety  17 , D Levinson  18 , F Navarro-Mateu  19 , B E Pennell  20 , N A Sampson  7 , K M Scott  21 , H Tachimori  22 , M Ten Have  23 , M C Viana  24 , D R Williams  25 , B J Wojtyniak  26 , Z Zarkov  27 , R C Kessler  7 , S Chatterji  28 , G Thornicroft
Affiliations

Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys

S Evans-Lacko et al. Psychol Med. 2018 Jul.

Abstract

Background: The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.

Methods: Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).

Results: Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).

Conclusions: The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.

Keywords: Education; WMH surveys; income; inequalities; mental disorders; mental health service use; occupation; population studies.

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Conflict of interest statement

Conflict of Interest: Dr. Evans-Lacko received consulting fees from Lundbeck, not connected to this research. In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The remaining authors declare no conflicts of interest.

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