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

Published online by Cambridge University Press:  20 October 2020

Daniel Vigo Open the ORCID record for Daniel Vigo [Opens in a new window] ,
Josep Maria Haro ,
Irving Hwang ,
Sergio Aguilar-Gaxiola ,
Jordi Alonso ,
Guilherme Borges ,
Ronny Bruffaerts ,
Jose Miguel Caldas-de-Almeida ,
Giovanni de Girolamo  and
Silvia Florescu
...Show all authors
Daniel Vigo*
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Josep Maria Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Irving Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Sergio Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
Jordi Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Pompeu Fabra University (UPF), Barcelona, Spain
Guilherme Borges
Affiliation:
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Ronny Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
Jose Miguel Caldas-de-Almeida
Affiliation:
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Giovanni de Girolamo
Affiliation:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Silvia Florescu
Affiliation:
National School of Public Health, Management and Development, Bucharest, Romania
Oye Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Elie Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Georges Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Viviane Kovess-Masfety
Affiliation:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Sing Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Fernando Navarro-Mateu
Affiliation:
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
Akin Ojagbemi
Affiliation:
Department of Psychiatry, University of Ibadan, Nigeria
Jose Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Kate Scott
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Juan Carlos Stagnaro
Affiliation:
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
Margreet ten Have
Affiliation:
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Maria Carmen Viana
Affiliation:
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
Chi-Shin Wu
Affiliation:
Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
Somnath Chatterji
Affiliation:
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
Pim Cuijpers
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands The Netherlands & EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
Graham Thornicroft
Affiliation:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Ronald C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
*
Author for correspondence: Daniel Vigo, E-mail: daniel.vigo@ubc.ca
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Abstract

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.

Keywords

Effective coveragemajor depressive disorderpharmacotherapypsychotherapytreatment
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 10 , July 2022 , pp. 1948 - 1958
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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