Delay and failure in treatment seeking after first onset ofmental disorders in the World Health Organizations World Mental Health SurveyInitiative

摘要

Data are presented on patterns of failure and delay in making initial treatment contact after first onset of a mental disorder in 15 countries in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Representative face-to-face household surveys were conducted among 76,012 respondents aged 18 and older in Belgium, Colombia, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, People's Republic of China (Beijing and Shanghai), Spain, and the United States. The WHO Composite International Diagnostic Interview (CIDI) was used to assess lifetime DSM-IV anxiety, mood, and substance use disorders. Ages of onset for individual disorders and ages of first treatment contact for each disorder were used to calculate the extent of failure and delay in initial help seeking. The proportion of lifetime cases making treatment contact in the year of disorder onset ranged from 0.8 to 36.4% for anxiety disorders, from 6.0 to 52.1% for mood disorders, and from 0.9 to 18.6% for substance use disorders. By 50 years, the proportion of lifetime cases making treatment contact ranged from 15.2 to 95.0% for anxiety disorders, from 7.9 to 98.6% for mood disorders, and from 19.8 to 86.1% for substance use disorders. Median delays among cases eventually making contactranged from 3.0 to 30.0 years for anxiety disorders, from 1.0 to 14.0 yearsfor mood disorders, and from 6.0 to 18.0 years for substance use disorders.Failure and delays in treatment seeking were generally greater in developingcountries, older cohorts, men, and cases with earlier ages of onset. Theseresults show that failure and delays in initial help seeking are pervasiveproblems worldwide. Interventions to ensure prompt initial treatment contactsare needed to reduce the global burdens and hazards of untreated mental disorders.