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. 2018 Mar;35(3):195-208.
doi: 10.1002/da.22711. Epub 2018 Jan 22.

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

Jordi Alonso  1   2   3 , Zhaorui Liu  4 , Sara Evans-Lacko  5   6 , Ekaterina Sadikova  7 , Nancy Sampson  7 , Somnath Chatterji  8 , Jibril Abdulmalik  9 , Sergio Aguilar-Gaxiola  10 , Ali Al-Hamzawi  11 , Laura H Andrade  12 , Ronny Bruffaerts  13 , Graça Cardoso  14 , Alfredo Cia  15 , Silvia Florescu  16 , Giovanni de Girolamo  17 , Oye Gureje  9 , Josep M Haro  18 , Yanling He  19 , Peter de Jonge  20   21 , Elie G Karam  22   23 , Norito Kawakami  24 , Viviane Kovess-Masfety  25 , Sing Lee  26 , Daphna Levinson  27 , Maria Elena Medina-Mora  28 , Fernando Navarro-Mateu  29 , Beth-Ellen Pennell  30 , Marina Piazza  31   32 , José Posada-Villa  33 , Margreet Ten Have  34 , Zahari Zarkov  35 , Ronald C Kessler  7 , Graham Thornicroft  5 ; WHO World Mental Health Survey Collaborators
Affiliations

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

Jordi Alonso et al. Depress Anxiety. 2018 Mar.

Abstract

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.

Keywords: adequate treatment; anxiety disorders; health services; perceived need for care; surveys.

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Conflict of interest statement

Conflicts of Interest

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.

Dr. Evans-Lacko received consulting fees from Lundbeck not connected to this research.

Dr. Haro received personal fees from Lundbeck.

Dr. Kawakami served as a consultant for Junpukai Foundation, SB At Work, Sekisui Co., Ltd., and received grant funding from Infosoft Technologies, Ministry of Health, Labour, and Welfare, and Japan Society for Promotion of Science.

The other authors report no biomedical financial interests or potential conflicts of interest.

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