Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder

Daniel Vigo; Josep Maria Haro; Irving Hwang; Sergio Aguilar-Gaxiola; Jordi Alonso; Guilherme Borges; Ronny Bruffaerts; Jose Miguel Caldas-de-Almeida; Giovanni de Girolamo; Silvia Florescu; Oye Gureje; Elie Karam; Georges Karam; Viviane Kovess-Masfety; Sing Lee; Fernando Navarro-Mateu; Akin Ojagbemi; Jose Posada-Villa; Nancy A. Sampson; Kate Scott; Juan Carlos Stagnaro; Margreet ten Have; Maria Carmen Viana; Chi-Shin Wu; Somnath Chatterji; Pim Cuijpers; Graham Thornicroft; Ronald C. Kessler; WHO World Mental Hlth Survey Colla

doi:10.1017/S0033291720003797

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Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder

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Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder

Daniel Vigo, Josep Maria Haro, Irving Hwang, Sergio Aguilar-Gaxiola, Jordi Alonso, Guilherme Borges, Ronny Bruffaerts, Jose Miguel Caldas-de-Almeida, Giovanni de Girolamo, Silvia Florescu, …

Psychological medicine, Vol.52(10), pp.1948-1958

01/07/2022

DOI: https://doi.org/10.1017/S0033291720003797

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https://hdl.handle.net/10523/19536

Abstract

Life Sciences & Biomedicine

Psychiatry

Psychology

Psychology, Clinical

Science & Technology

Social Sciences

Background Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. Methods Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. Results MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. Conclusions Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.

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Record Identifier: 9926495389301891
Title: Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder
Creators: Daniel Vigo
Josep Maria Haro
Irving Hwang
Sergio Aguilar-Gaxiola
Jordi Alonso
Guilherme Borges
Ronny Bruffaerts
Jose Miguel Caldas-de-Almeida
Giovanni de Girolamo
Silvia Florescu
Oye Gureje
Elie Karam
Georges Karam
Viviane Kovess-Masfety
Sing Lee
Fernando Navarro-Mateu
Akin Ojagbemi
Jose Posada-Villa
Nancy A. Sampson
Kate Scott
Juan Carlos Stagnaro
Margreet ten Have
Maria Carmen Viana
Chi-Shin Wu
Somnath Chatterji
Pim Cuijpers
Graham Thornicroft
Ronald C. Kessler
WHO World Mental Hlth Survey Colla
Publication Details: Psychological medicine, Vol.52(10), pp.1948-1958
Academic Unit: Psychological Medicine (DSM)
Publisher: Cambridge Univ Press
Grant note: WHO (Geneva); World Health Organization Ministry of Social Protection Algorithm World Health Organization Substance Abuse and Mental Health Services Administration (SAMHSA); United States Department of Health & Human Services Eli Lilly and Company; Eli Lilly 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 Lundbeck; Lundbeck Corporation Fundacion para la Formacion e Investigacion Sanitarias (FFIS) of Murcia Glaxo Smith Kline; GlaxoSmithKline INPRFMDIES 4280 / National Institute of Psychiatry Ramon de la Fuente OmniPharma CONACyT-G30544-H / National Council on Science and Technology 044708 / Robert Wood Johnson Foundation (RWJF) FIS 00/0028 / Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain; Instituto de Salud Carlos III Health Canada, Saint Paul's Hospital Foundation Eli Lilly Servier 03/00204-3 / State of Sao Paulo Research Foundation (FAPESP); Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) Pfizer Ministry of Health National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research Pan American Health Organization University of British Columbia WHO (Lebanon); World Health Organization 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) Center for Excellence on Research in Mental Health (CES University) SAF 2000-158-CE / Ministerio de Ciencia y Tecnologia, Spain; Spanish Government Bella Pharma Champalimaud Foundation MR/S001255/1 / UK Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) Ortho-McNeil Pharmaceutical Inc. John W. Alden Trust 2017 SGR 452; 2014 SGR 748 / Generalitat de Catalunya Lebanese Ministry of Public Health Bristol-Myers Squibb Piedmont Region (Italy); Regione Piemonte; Instituto de Salud Carlos III Gulbenkian Foundation CIBER CB06/02/0046; RETICS RD06/0011 REM-TAP / Instituto de Salud Carlos III; Spanish Government Pan-American Health Organization UPO NIHR Asset Global Health Unit award Harvard Medical School MR/R023697/1 / Indigo Partnership Pfizer Foundation 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) Pan American Health Organization (PAHO) Ministry of Public Health (former Ministry of Health) Phenicia 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 Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejeria de Sanidad y Politica Social) AstraZeneca Foundation for Science and Technology (FCT); Fundacao para a Ciencia e a Tecnologia (FCT) Benta Eli Lilly Romania SRL; Eli Lilly Novartis 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) Care South London at King's College London NHS Foundation Trust Secretary of Health of Medellin R01MH100470 / National Institute of Mental Health of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) 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 NIHR Applied Research Collaboration South London Federal Ministry of Health, Abuja, Nigeria QLG5-1999-01042; SANCO 2004123; EAHC 20081308 / European Commission; European Union (EU); European Commission Joint Research Centre
Date published ; e-published: 01/07/2022
Language: English
Resource Type ; Subtype: Journal article

Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder

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