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Original Contribution
June 2, 2004

Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys

The WHO World Mental Health Survey Consortium
Author Affiliations

Authors: Belgium: Koen Demyttenaere, Ronny Bruffaerts; Colombia: Jose Posada-Villa; France: Isabelle Gasquet, Viviane Kovess, Jean Pierre Lepine; Germany: Matthias C. Angermeyer, Sebastian Bernert; Italy: Giovanni de Girolamo, Pierluigi Morosini, Gabriella Polidori; Japan: Takehiko Kikkawa, Norito Kawakami, Yutaka Ono, Tadashi Takeshima, Hidenori Uda; Lebanon: Elie G. Karam, John A. Fayyad, Aimee N. Karam, Zeina N. Mneimneh; Mexico: Maria Elena Medina-Mora, Guilherme Borges, Carmen Lara; the Netherlands: Ron de Graaf, Johan Ormel; Nigeria: Oye Gureje; People's Republic of China Beijing: Yucun Shen, Yueqin Huang; People's Republic of China Shanghai: Mingyuan Zhang; Spain: Jordi Alonso, Josep Maria Haro, Gemma Vilagut; Ukraine: Evelyn J. Bromet, Semyon Gluzman, Charles Webb; United States: Ronald C. Kessler, Kathleen R. Merikangas, James C. Anthony, Michael R. Von Korff, Philip S. Wang; ESEMeD/MHEDEA 2000 Consortium in Belgium, France, Germany, Italy, the Netherlands, and Spain: Jordi Alonso, Traolach S. Brugha; PAHO WMH Consortium in Colombia and Mexico: Sergio Aguilar-Gaxiola; Asia-Pacific WMH Consortium in Japan and the People's Republic of China: Sing Lee; WMH Data Collection Coordinating Center: Steven Heeringa, Beth-Ellen Pennell; WMH Data Analysis Coordinating Center: Alan M. Zaslavsky; WHO: T. Bedirhan Ustun, Somnath Chatterji. Drs Kessler and Ustun are coprincipal investigators of the overall WMH Survey Initiative.

JAMA. 2004;291(21):2581-2590. doi:10.1001/jama.291.21.2581

Context Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries.

Objective To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative.

Design, Setting, and Participants Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia.

Main Outcome Measures The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview.

Results The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.

Conclusions Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.