Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

Daniel Fernandez; Daniel Vigo; Nancy A. Sampson; Irving Hwang; Sergio Aguilar-Gaxiola; Ali O. Al-Hamzawi; Jordi Alonso; Laura Helena Andrade; Evelyn J. Bromet; Giovanni de Girolamo; Peter de Jonge; Silvia Florescu; Oye Gureje; Hristo Hinkov; Chiyi Hu; Elie G. Karam; Georges Karam; Norito Kawakami; Andrzej Kiejna; Viviane Kovess-Masfety; Maria E. Medina-Mora; Fernando Navarro-Mateu; Akin Ojagbemi; Siobhan O'Neill; Marina Piazza; Jose Posada-Villa; Charlene Rapsey; David R. Williams; Miguel Xavier; Yuval Ziv; Ronald C. Kessler; Josep M. Haro; World Hlth Org World Mental Hlth

doi:10.1017/S0033291720000884

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Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

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Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

Daniel Fernandez, Daniel Vigo, Nancy A. Sampson, Irving Hwang, Sergio Aguilar-Gaxiola, Ali O. Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Evelyn J. Bromet, Giovanni de Girolamo, …

Psychological medicine, Vol.51(12), pp.2104-2116

01/09/2021

DOI: https://doi.org/10.1017/S0033291720000884

Handle:

https://hdl.handle.net/10523/22677

Abstract

Life Sciences & Biomedicine

Psychiatry

Psychology

Psychology, Clinical

Science & Technology

Social Sciences

Background There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. Methods Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. Results Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. Conclusions Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

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Record Identifier: 9926495512101891
Title: Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative
Creators: Daniel Fernandez
Daniel Vigo
Nancy A. Sampson
Irving Hwang
Sergio Aguilar-Gaxiola
Ali O. Al-Hamzawi
Jordi Alonso
Laura Helena Andrade
Evelyn J. Bromet
Giovanni de Girolamo
Peter de Jonge
Silvia Florescu
Oye Gureje
Hristo Hinkov
Chiyi Hu
Elie G. Karam
Georges Karam
Norito Kawakami
Andrzej Kiejna
Viviane Kovess-Masfety
Maria E. Medina-Mora
Fernando Navarro-Mateu
Akin Ojagbemi
Siobhan O'Neill
Marina Piazza
Jose Posada-Villa
Charlene Rapsey
David R. Williams
Miguel Xavier
Yuval Ziv
Ronald C. Kessler
Josep M. Haro
World Hlth Org World Mental Hlth
Publication Details: Psychological medicine, Vol.51(12), pp.2104-2116
Academic Unit: Psychological Medicine (DSM)
Publisher: Cambridge Univ Press
Grant note: National Center for Public Health Protection WHO (Geneva); World Health Organization Ministry of Social Protection National Institute of Health of the Ministry of Health of Peru 16/50307-3; 03/00204-3 / Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP); Fundacao de Amparo a Pesquisa e Inovacao do Estado de Santa Catarina (FAPESC) Federal Ministry of Health, Abuja, Nigeria - Health & Social Care Research & Development Division of the Public Health Agency H13-SHOGAI023; H14-TOKUBETSU-026; H16-KOKORO-013; H25-SEISHIN-IPPAN006 / Grant for Research on Psychiatric and Neurological Diseases and Mental Health 307784/2016-9 / Brazilian Council for Scientific and Technological Development (CNPq); Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ) R01-MH059575 / US National Institute of Mental Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) Substance Abuse and Mental Health Services Administration (SAMHSA); United States Department of Health & Human Services Eli Lilly and Company; Eli Lilly Nigerian Survey of Mental Health and Wellbeing R03 TW006481-01 / National Institute of Health/Fogarty International Center; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) WHO (Nigeria); World Health Organization Health Research Council; Health Research Council of New Zealand Shenzhen Bureau of Health Norwegian Financial Mechanism - Polish Ministry of Health Glaxo Smith Kline; GlaxoSmithKline Iraqi IMHS team Benta, Bella Pharma CONACyT-G30544-H / National Council on Science and Technology Department of Mental Health EEA Financial Mechanism 03/00204-3 / State of Sao Paulo Research Foundation (FAPESP); Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) Ministry of Health CIBER CB06/02/0046 / Instituto de Salud Carlos III; Spanish Government Pan American Health Organization NOVA University of Lisbon - Champalimaud Foundation, Gulbenkian Foundation Japan Ministry of Health, Labour, and Welfare; Ministry of Health, Labour and Welfare, Japan WHO (Lebanon); World Health Organization University of Michigan; University of Michigan System R01 MH070884 / United States National Institute of Mental Health (NIMH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) SAF 2000-158-CE / Ministerio de Ciencia y Tecnologia, Spain; Spanish Government Ortho-McNeil Pharmaceutical Inc. FIS 00/0028 / [Piedmont Region (Italy)], Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain; Instituto de Salud Carlos III; Regione Piemonte John W. Alden Trust INPRFMDIES 4280 / Servier Lebanese Ministry of Public Health SGR 622 (GRBIO) Bristol-Myers Squibb South Africa Stress and Health Study Grant16/50307-3; RTI2018-100927-J-I00 / State of Sao Paulo Research Foundation; Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) PL 0256 / Polish project Epidemiology of Mental Health and Access to Care -EZOP Project European Funds through United Nations Development Group Iraq Trust Fund - Ministry of Health Pfizer Foundation 2002-17270/13-5 / Argentinian Ministry of Health (Ministerio de Salud de la Nacion) National Institute of Drug Abuse (NIDA); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Drug Abuse (NIDA) Shenzhen Bureau of Science, Technology Pan American Health Organization (PAHO) World Health Organization World Mental Health National Institute of Drug Abuse; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Drug Abuse (NIDA) 044708 / Robert Wood Johnson Foundation; Robert Wood Johnson Foundation (RWJF) Israel National Institute for Health Policy and Health Services Research John D. and Catherine T. MacArthur Foundation R13-MH066849; R01-MH069864; R01 DA016558 / United States Public Health Service; United States Department of Health & Human Services Lebanese Evaluation of the Burden of Ailments and Needs of the Nation Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejeria de Sanidad y Politica Social) New Zealand Ministry of Health, Alcohol Advisory Council Foundation for Science and Technology (FCT); Fundacao para a Ciencia e a Tecnologia (FCT) Generalitat de Catalunya QLG5-1999-01042; SANCO 2004123; EAHC 20081308 / Center for Excellence on Research in Mental Health - European Commission U01-MH60220 / National Institute of Mental Health (NIMH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) Ministry of Health - Ministry of Public Health RO1-MH61905 / Fundacion para la Formacion e Investigacion Sanitarias (FFIS) of Murcia - US National Institute of Mental Health FIRCA R03-TW006481 / Fogarty International Center; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) GlaxoSmithKline E2987-3648 / European Regional Development Fund FEDER (FEDER); European Union (EU); Marie Curie Actions National Insurance Institute of Israel Agencia Estatal de Investigacion (AEI, Spain); Spanish Government World Mental Health Japan
Date published ; e-published: 01/09/2021
Language: English
Resource Type ; Subtype: Journal article

Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

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