Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys
Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys
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DOI：
10.1001/jama.291.21.2581
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发表时间：
2004-06-02
影响因子：
120.7
通讯作者：
Chatterji, S
中科院分区：
文献类型：
--
作者：
Demyttenaere, K;Bruffaerts, R;Chatterji, S
背景
对于未治疗的精神障碍的程度或严重性，人们知之甚少，尤其是在欠发达国家。
目的
在世界卫生组织（WHO）世界精神卫生（WMH）调查倡议中，对14个国家（6个欠发达国家，8个发达国家）的《精神障碍诊断与统计手册》第四版（DSM - IV）精神障碍的患病率、严重性和治疗情况进行评估。
设计、环境和参与者
2001年至2003年在美洲、欧洲、中东、非洲和亚洲的14个国家对60463名社区成年人进行面对面的家庭调查。
主要观察指标
使用世界精神卫生版的世界卫生组织复合性国际诊断访谈（WMH - CIDI），一种完全结构化的、由非专业人员实施的精神疾病诊断访谈，对DSM - IV精神障碍、严重性和治疗情况进行评估。
结果
前一年患有任何WMH - CIDI/DSM - IV精神障碍的患病率差异很大，从上海的4.3%到美国的26.4%不等，四分位距（IQR）为9.1% - 16.9%。在12个月的病例中，33.1%（哥伦比亚）到80.9%（尼日利亚）为轻度（IQR，40.2% - 53.3%）。严重的精神障碍与严重的角色功能障碍有关。尽管在几乎所有国家，精神障碍的严重程度与接受治疗的可能性相关，但在发达国家，35.5%到50.3%的严重病例以及在欠发达国家，76.3%到85.4%的严重病例在访谈前的12个月内未接受治疗。由于轻度和亚阈值病例的高患病率，在每个国家，接受治疗的人数远远超过未治疗的严重病例的人数。
结论
重新分配治疗资源可大幅减少严重病例中精神障碍治疗需求未得到满足的问题。这种重新分配存在结构性障碍。需要仔细考虑治疗一些轻度病例的价值，特别是那些有发展为更严重精神障碍风险的病例。
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 60463 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.