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Errazuriz A, Avello-Vega D, Ramirez-Mahaluf JP, Torres R, Crossley NA, Undurraga EA, Jones PB. Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100587. [PMID: 37701460 PMCID: PMC10493603 DOI: 10.1016/j.lana.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/12/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
Background Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR). Methods We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054). Findings Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR. Interpretation We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region. Funding Pfizer Independent Medical Education Grant.
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Affiliation(s)
- Antonia Errazuriz
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Research on Depression and Personality-MIDAP, Santiago, Chile
| | - Dalia Avello-Vega
- Regional Research Institute, School of Social Work, Portland State University, Oregon, United States
| | - Juan P. Ramirez-Mahaluf
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rafael Torres
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Nicolas A. Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- NIHR Applied Research Collaboration East of England, CPFT, Cambridge, United Kingdom
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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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3
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Czyżowska N, Gurba E. Enhancing Meaning in Life and Psychological Well-Being Among a European Cohort of Young Adults via a Gratitude Intervention. Front Psychol 2022; 12:751081. [PMID: 35058837 PMCID: PMC8763971 DOI: 10.3389/fpsyg.2021.751081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Strengthening the sense of meaning in life and psychological well-being brings benefits for mental health. The group particularly vulnerable to mental problems are young adults, therefore the aim of our research was to explore how a gratitude intervention will affect the sense of meaning in life, psychological well-being, general health and perceived stress among them. The research also took into account the issue of expressing gratitude. Method: The study involved 80 young adults (58 women and 22 men) who were randomly assigned to the experimental group that filled out the specially prepared diaries for a week (participants were asked to list three things for which they feel grateful, to whom they are grateful and if and how they expressed their gratitude) or the control group. Participants completed the Meaning in Life Questionnaire (MLQ), the General Health Questionnaire – 28 (GHQ-28), the Perceived Stress Scale (PSS), and the Ryff Scales of Psychological Well-Being (PWBS) twice (before and after intervention). Results: In the experimental group significant increases were observed in three areas of psychological well-being: environmental mastery, relationships with others and purpose in life. The significant decrease was also noted in anxiety/insomnia and depression symptoms as well as in perceived stress. There were no differences in the level of meaning in life. There was a positive relationship between expressing gratitude and meaning in life and psychological well-being. Conclusion: Proposed gratitude intervention has the potential to enhance psychological well-being among young adults, however, it may not be effective in enhancing meaning in life.
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Affiliation(s)
- Natalia Czyżowska
- Department of Pedagogy and Psychology, Institute of Psychology, Pedagogical University of Kraków, Kraków, Poland
| | - Ewa Gurba
- Department of Philosophy, The Pontifical University of John Paul II, Kraków, Poland
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Torrente F, Yoris A, Low D, Lopez P, Bekinschtein P, Vázquez GH, Manes F, Cetkovich M. Psychological symptoms, mental fatigue and behavioural adherence after 72 continuous days of strict lockdown during the COVID-19 pandemic in Argentina. BJPsych Open 2022; 8:e10. [PMID: 34931146 PMCID: PMC8668400 DOI: 10.1192/bjo.2021.1065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An early and prolonged lockdown was adopted in Argentina during the first wave of COVID-19. Early reports evidenced elevated psychological symptoms. AIMS To explore if the prolonged lockdown was associated with elevated anxiety and depressive symptoms; if mental fatigue was associated with lockdown adherence (a phenomenon called 'behavioural fatigue'); and if financial concerns were associated with lockdown adherence and emotional symptoms. METHOD The survey included standardised questionnaires to assess depressive (PHQ-9) and anxious (GAD-7) symptoms, mental fatigue, risk perception, lockdown adherence, financial concerns, daily stress, loneliness, intolerance to uncertainty, negative repetitive thinking and cognitive problems. LASSO regression analyses were carried out to predict depression, anxiety and lockdown adherence. RESULTS The survey reached 3617 adults (85.2% female) from all provinces of Argentina after 72 days of lockdown. Data were collected between 21 May 2020 and 4 June 2020. In that period, Argentina had an Oxford stringency index of 85/100. Of those surveyed, 45.6% and 27% met the cut-offs for depression and anxiety, respectively. Mental fatigue, cognitive failures and financial concerns were correlated with psychological symptoms, but not with adherence to lockdown. In regression models, mental fatigue, cognitive failures and loneliness were the most important variables to predict depression, intolerance to uncertainty and lockdown difficulty were the most important for anxiety, and perceived threat was the most important for predicting lockdown adherence. CONCLUSIONS During the extended lockdown, psychological symptoms increased, being enhanced by mental fatigue, cognitive difficulties and financial concerns. We found no evidence of behavioural fatigue. Thus, feeling mentally fatigued is not the same as being behaviourally fatigued.
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Affiliation(s)
- Fernando Torrente
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
| | - Adrian Yoris
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
| | - Daniel Low
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School and MIT, USA
| | - Pablo Lopez
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
| | - Pedro Bekinschtein
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
| | | | - Facundo Manes
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
| | - Marcelo Cetkovich
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina; and Institute of Cognitive and Translational Neurosciences, National Council of Science and Technology, INECO Foundation and Favaloro University, Argentina
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Lucuix MB, Gómez-Salgado J, Barone ME, Domínguez-Salas S, Luque LE, Rodríguez-Domínguez C, Ruiz-Frutos C. Psychological distress during the COVID-19 pandemic in the population of Argentina. Medicine (Baltimore) 2021; 100:e28333. [PMID: 34941136 PMCID: PMC8701755 DOI: 10.1097/md.0000000000028333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/30/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT In addition to the implications that this pandemic has had on physical health, there are other circumstances that threaten the mental health of the population, such as lockdown measures to prevent the spread of the virus, uncertainty, and the increase in infections and deaths. For this reason, this study explored indicators of psychological distress in the Argentine population, as well as its relationship with sociodemographic and health variables.Cross-sectional observational study, with data collection from May to August 2020. A total of 1112 people over the age of 18 who responded to various measurement instruments through an online questionnaire participated. A bivariate analysis and logistic regression were carried out in order to determine predictive factors of psychological distress.The data revealed that 60.9% of the sample presented psychological distress. A greater number with this condition was observed in women, apart from younger people, with a greater number of symptoms associated with the disease and with worse self-perceived health. There was no evidence of association between psychological distress and contact with people infected with coronavirus disease 2019 or with material suspicious of being infected.This research provided an overview of the mental health status of a significant population sample in Argentina, months after the onset of the coronavirus disease 2019 pandemic. These findings complement those found in other national and international studies, allowing the accumulation of evidence that states the need to demand to draw attention to the mental health of the population, especially the most vulnerable groups, on behalf of the public authorities.
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Affiliation(s)
- María Beatriz Lucuix
- Social Work Career, Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Myriam E. Barone
- Instituto de Estudios Sociales y Humanos, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Humanidades y Ciencias Sociales, Universidad Nacional de Misiones, Posadas, Argentina
| | | | | | | | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Wechsler TF, Pfaller M, van Eickels RE, Schulz LH, Mühlberger A. Look at the Audience? A Randomized Controlled Study of Shifting Attention From Self-Focus to Nonsocial vs. Social External Stimuli During Virtual Reality Exposure to Public Speaking in Social Anxiety. Front Psychiatry 2021; 12:751272. [PMID: 34970163 PMCID: PMC8712494 DOI: 10.3389/fpsyt.2021.751272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli. Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects. Results: Within the analysis sample (n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group. Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.
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Affiliation(s)
- Theresa F. Wechsler
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
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Compte EJ, Nagata JM, Sepúlveda AR, Silva BC, Cortes C, Bidacovich G, Brown TA, Blashill AJ, Lavender JM, Mitchison D, Mond JM, Castillo I, López PL, Muiños R, Rutsztein G, Torrente F, Murray SB. Development and validation of a multicultural Spanish-language version of the Muscularity-Oriented Eating Test (MOET) in Argentina. Eat Behav 2021; 43:101542. [PMID: 34492593 DOI: 10.1016/j.eatbeh.2021.101542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022]
Abstract
The utility of traditional eating disorder measures in the assessment of muscularity-oriented disordered eating has been questioned. To address this limitation, the Muscularity-Oriented Eating Test (MOET) was recently developed and validated in a sample of U.S. college men. We aimed to develop a multicultural Spanish-language version of the MOET for use in Latin American samples and validate its use in a sample of Argentinian college men. Combined translation procedures were used to develop a version suitable for different Spanish-speaking populations. A total of 235 students (Mage = 23.47, SD = 5.61) participated in this study by completing a survey including the MOET. A sub-sample (n = 121) completed the MOET again after 1 week. A confirmatory factor analysis of a re-specified model of the original single-factor MOET, allowing for residual correlation between items associated to dietary rules (items 4-12), resulted in an adequate fit (χ2/df = 2.10, CFI = 0.94, TLI = 0.93, RMSEA 0.05 [90% CI = 0.04, 0.06] SRMR = 0.08). Further, the multicultural Spanish-language version of the MOET yielded evidence of internal consistency (omega = 0.83, 95% CI [0.79, 0.88], Cronbach's α = 0.83), a 1-week Intraclass Correlation Coefficient was considered for test-retest reliability (ICC = 0.82), item analysis, convergent validity with measures of eating disorder psychopathology, body dissatisfaction and weight-related behaviors, as well as for divergent validity with an unrelated construct. The availability of a multicultural Spanish-language version of the MOET may have utility in both clinical and research efforts related to muscularity-oriented disordered eating among Latino men.
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Affiliation(s)
- Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; School of Human and Behavioral Science, Favaloro University, Buenos Aires, Argentina; Eating Behavior Research Center (CECA), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Ana R Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - B Camila Silva
- School of Human and Behavioral Science, Favaloro University, Buenos Aires, Argentina
| | - Camila Cortes
- School of Human and Behavioral Science, Favaloro University, Buenos Aires, Argentina
| | - German Bidacovich
- School of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, USA; San Diego State/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia; Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Jonathan M Mond
- Center for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Irais Castillo
- Nutrition Program, Nursing School, Autonomous University of Zacatecas, Mexico
| | - Pablo L López
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Roberto Muiños
- School of Psychology, University of Buenos Aires, Buenos Aires, Argentina; School of Statistics - National University of Tres de Febrero, Buenos Aires, Argentina
| | | | - Fernando Torrente
- Center for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
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Torrente F, Yoris A, Low D, Lopez P, Bekinschtein P, Manes F, Cetkovich M. Sooner than you think: A very early affective reaction to the COVID-19 pandemic and quarantine in Argentina. J Affect Disord 2021; 282:495-503. [PMID: 33422827 PMCID: PMC8529255 DOI: 10.1016/j.jad.2020.12.124] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/28/2020] [Accepted: 12/24/2020] [Indexed: 11/24/2022]
Abstract
The unique circumstances created by the COVID-19 pandemic pose serious challenges to mood stability and emotional regulation at all ages. Although many people tend to react resiliently to stress, others appear to display emotional anxiety and depression-related symptoms. In this study, we carried out a survey (N = 10,053) during the first week of the general lockdown (quarantine) in Argentina to measure early affective reactions in Argentine adults. Respondents showed substantial anxious and depressive symptoms, with 33% and 23% of participants reporting possible depressive and anxious syndromes, respectively, with the youngest group (18 to 25 y.o.) showing the highest prevalence of symptoms. Even if prior mental health problems predisposed or aggravated the reaction, participants without prior complaints showed signs of psychological impact. Using linear regression, the most important independent variables related to depressive symptoms were the feeling of loneliness followed by daily stress. In the case of anxious states, the strongest variables were negative repetitive thinking and feeling of loneliness. Other psychological, economic, and social factors are discussed. This study is in line with previous literature that highlight the importance of the psychological impact of pandemics, but additionally demonstrates that these reactions are present at a large scale immediately after the start of quarantine with very low infectious rates as an early anticipatory adaptive reaction leading to potential negative outcomes from adjustment disorders to major disorders. In addition, the present results provide potentially relevant information about sudden environmental impacts on affective states and specific pathways for anxiety and depression to be expressed. We end by discussing implications for public policy based on considering the most vulnerable groups.
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Affiliation(s)
- F. Torrente
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina,Corresponding author
| | - A. Yoris
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina
| | - D.M. Low
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School & MIT, USA
| | - P. Lopez
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina
| | - P. Bekinschtein
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina
| | - F. Manes
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina
| | - M. Cetkovich
- Institute of Neuroscience and Public Policy, INECO Foundation, Argentina,Institute of Cognitive and Translational Neurosciences, (INECO Foundation-Favaloro University-CONICET), Argentina
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Hernández-Vásquez A, Vargas-Fernández R, Bendezu-Quispe G, Grendas LN. Depression in the Peruvian population and its associated factors: analysis of a national health survey. J Affect Disord 2020; 273:291-297. [PMID: 32421615 DOI: 10.1016/j.jad.2020.03.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/29/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, the factors associated with the presence of depression or depressive symptoms in the Peruvian population have not been described. This study aimed to determine the prevalence of clinically relevant depressive symptoms in the Peruvian population and its associated factors. METHODS A cross-sectional analytical study of secondary data from 2018 Demographic and Family Health Survey was conducted. The survey database includes 31,996 participants over 18 years of age. The dependent variable of the analysis was the presence of depression during the 14 days before the survey measured by the Patient Health Questionnaire (PHQ-9). Factors associated with the presence of depression were estimated with a proportional odds logistic regression model. RESULTS The overall prevalence of clinically relevant depressive symptoms was 6.4% (moderate and severe symptomatology in 3.9% [95% CI: 3.6-4.3] and 2.5% [95% CI: 2.2-2.7], respectively). Being a woman, belonging to the age groups of 45 to 64 years or 65 or older, living in the Andean region, and having high blood pressure or diabetes mellitus or some disability increased the probability of having clinically relevant depressive symptoms. LIMITATIONS The use of the PHQ-9 tool to assess depressive symptomatology limits the evaluation to a period of two weeks before the survey, requiring further study for diagnosis confirmation. CONCLUSION Six out of 100 Peruvians presented moderate to severe clinically relevant depressive symptoms in 2018. Strategies for depression should contemplate population subgroups , such as women and patients with chronic diseases and disabilities.
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Affiliation(s)
- Akram Hernández-Vásquez
- Universidad Nacional Mayor de San Marcos. Lima, Peru; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud. Lima, Peru.
| | | | - Guido Bendezu-Quispe
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru.
| | - Leandro Nicolás Grendas
- Instituto de Farmacología, Facultad de Medicina. Universidad de Buenos Aires. Buenos Aires, Argentina; Hospital General de Agudos "T. Álvarez". Buenos Aires, Argentina.
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10
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Alangari AS, Knox SS, Kristjansson AL, Wen S, Innes KE, Bilal L, Alhabeeb A, Al-Subaie AS, Altwaijri YA. Barriers to Mental Health Treatment in the Saudi National Mental Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3877. [PMID: 32486182 PMCID: PMC7311952 DOI: 10.3390/ijerph17113877] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
Objectives: To examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a community-based epidemiological survey in a nationally representative household sample of respondents aged 15-65 in the Kingdom of Saudi Arabia. The World Health Organization Composite International Diagnostic Interview (CIDI) 3.0 was used. Predictors of barriers to treatment were analyzed with multivariable logistic regression. Results: Among participants with a 12-month DSM-IV/CIDI disorder (n = 711), 86.1% reported no service use. Of those (n = 597), 50.7% did not think they needed any help (categorized as "low perceived need") and 49.3% did perceive need. Of those who perceived need (n = 309), the majority (98.9%) reported attitudinal barriers to initiation. In contrast, 10.3% of those with a perceived need reported structural barriers. Respondents who were previously married or indicated below-average income were more likely to believe they needed help. Conclusions: Among people with a diagnosed mental disorder, low perceived need and attitudinal barriers are the primary barriers to mental health treatment in the KSA. The results suggest that addressing poor mental health literacy may be essential factor in reducing the unmet need for mental health treatment in the KSA.
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Affiliation(s)
- Abdulaziz S. Alangari
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; (S.S.K.); (K.E.I.)
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Sarah S. Knox
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; (S.S.K.); (K.E.I.)
| | - Alfgeir L. Kristjansson
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA;
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26506, USA;
| | - Kim E. Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; (S.S.K.); (K.E.I.)
| | - Lisa Bilal
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (L.B.); (Y.A.A.)
- King Salman Center for Disability Research, Riyadh 12512, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Abdulhameed Alhabeeb
- National Center for Mental Health Promotion, Ministry of Health, Riyadh 11525, Saudi Arabia;
| | - Abdullah S. Al-Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia;
- Edrak Medical Center, Riyadh 12281, Saudi Arabia
| | - Yasmin A. Altwaijri
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (L.B.); (Y.A.A.)
- King Salman Center for Disability Research, Riyadh 12512, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia;
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11
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Burrone MS, Alvarado R, Colantonio LD, Enders JE, Abeldaño Zuñiga RA, Valencia E, Susser E, Fernández RA. Prevalence of Mood and Anxiety Disorders Among Adults Seeking Care in Primary Healthcare Centers in Cordoba, Argentina. Front Psychiatry 2020; 11:232. [PMID: 32292359 PMCID: PMC7118212 DOI: 10.3389/fpsyt.2020.00232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of mood and anxiety disorders among adults seeking care in primary healthcare centers in Cordoba city, Argentina. METHODS Cross-sectional analysis of a random sample of adults 18-69 years of age seeking care for general health problems in public (i.e., government-funded) primary healthcare centers in Cordoba city, Argentina in 2010-2011. Mood and anxiety disorders were assessed in the participants' lifetime, and in the last 12 months and 30 days using the World Mental Health Composite International Diagnostic Interview 3.0, and defined following the International Classification of Diseases, tenth revision. RESULTS Overall, 1,067 participants were included in the current analysis [mean age 35.6 (SD 13.2) years, 83.7% female]. The lifetime, 12-month and 30-day prevalence of any mood or anxiety disorder was 40.4% [95% confidence interval (95%CI) 37.4-43.4%], 20.1% (17.8-22.7%) and 7.8% (6.2-9.6%), respectively. The prevalence of anxiety disorders was higher compared to mood disorders when assessed in the participants' lifetime [29.7% (95%CI 27.0-32.5%) versus 19.3% (17.0-21.8%)], and in the last 12 months [14.9% (12.8-17.2%) versus 8.7% (7.1-10.6%)] and 30 days [5.8% (4.5-7.4%) versus 2.3% (1.5-3.4%)]. Age and marital status-adjusted odds ratios for any mood or anxiety disorder in the participants' lifetime and in the last 12 months and 30 days comparing women versus men were 1.19 (95%CI 0.85-1.67), 1.70 (1.07-2.69), and 2.26 (1.02-5.00), respectively. CONCLUSION The prevalence of mood and anxiety disorders is high among adults seeking care in primary healthcare centers in Cordoba city, particularly among women. Integration of primary and mental health services is warranted.
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Affiliation(s)
- María Soledad Burrone
- Instituto de Ciencias de la Salud, Universidad de O´Higgins, Rancagua, Chile.,Escuela de Salud Pública, Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O´Higgins, Rancagua, Chile.,Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julio E Enders
- Escuela de Salud Pública, Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Roberto Ariel Abeldaño Zuñiga
- División de Estudios de Posgrado, Universidad de la Sierra Sur - Consejo Nacional de Ciencia y Tecnología, Oaxaca, México
| | - Eliecer Valencia
- Instituto de Ciencias de la Salud, Universidad de O´Higgins, Rancagua, Chile.,Department of Epidemiology, Columbia University, New York, NY, United States
| | - Ezra Susser
- Department of Epidemiology, Columbia University, New York, NY, United States.,Division of Health Policy and Behavioural Science, New York State Psychiatric Institute, New York, NY, United States
| | - Ruth A Fernández
- Escuela de Salud Pública, Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba, Córdoba, Argentina
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12
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Compte EJ, Nagata JM, Sepúlveda AR, Rivas A, Sbdar LS, Menga S, Rica R, Torrente F, Murray SB. Assessment and validation of a Spanish version of the Muscle Dysmorphia Disorder Inventory in Argentinian men who exercise: Inventario de Dismorfia Muscular. Body Image 2019; 31:24-34. [PMID: 31430602 DOI: 10.1016/j.bodyim.2019.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
Despite an increase in body dissatisfaction and muscularity concerns among Latin American men, there is a paucity of research relating to muscle dysmorphia in this population. In this study we aimed to evaluate, for the first time in Latin America, the factor structure of the Muscle Dysmorphic Disorder Inventory (MDDI; Hildebrandt, Langenbucher, & Schlundt, 2004). A sample of 551 men who exercise completed measures of body dissatisfaction, disordered eating, and the MDDI. Exploratory factor analysis in a first split-half sample revealed a 3-factor solution similar to the original version, which was then tested through confirmatory factor analysis (CFA) in a second split-half sample. A re-specified model (allowing for error correlations between Items 10-13 and 11-13) presented adequate fit. Omega coefficients revealed adequate internal consistency (> .80) for the Drive for Size and Functional Impairment subscales. The internal consistency for the Appearance Intolerance subscale was .74 and .72 across subset samples. Associations with body dissatisfaction, disordered eating, body mass index, and frequency of training and rest days are presented as evidence of construct validity. Finally, multi-group CFA indicated that the model was invariant across type of exercise. Overall, these data suggest that the MDDI is suitable for use in Spanish-speaking Latin American male populations.
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Affiliation(s)
- Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina; DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina.
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Ana R Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Andrés Rivas
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Lara S Sbdar
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Sol Menga
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Robin Rica
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Fernando Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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13
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Wechsler TF, Kümpers F, Mühlberger A. Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Front Psychol 2019; 10:1758. [PMID: 31551840 PMCID: PMC6746888 DOI: 10.3389/fpsyg.2019.01758] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is in vivo exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and in vivo exposure in studies applying an equivalent amount of exposure in both treatments is necessary. Methods: We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and in vivo. We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' g effect sizes for the treatment effects of VR exposure, in vivo exposure, and the comparison of VR to in vivo exposure in all studies and separately for studies on each diagnosis. Results: Nine studies (n = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and in vivo exposure both showed large, significant effect sizes. The comparison of VR to in vivo exposure revealed a small, but non-significant effect size favoring in vivo (g = -0.20). Specifically, effect sizes for Specific Phobia (g = -0.15) and Agoraphobia (g = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring in vivo (g = -0.50). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring in vivo exposure. Conclusions: We found no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
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Affiliation(s)
- Theresa F. Wechsler
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
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14
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Borges G, Aguilar-Gaxiola S, Andrade L, Benjet C, Cia A, Kessler RC, Orozco R, Sampson N, Stagnaro JC, Torres Y, Viana MC, Medina-Mora ME. Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys. Epidemiol Psychiatr Sci 2019; 29:e53. [PMID: 31452485 PMCID: PMC8061239 DOI: 10.1017/s2045796019000477] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 11/25/2022] Open
Abstract
AIMS To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. METHODS Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. RESULTS Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. CONCLUSIONS These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.
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Affiliation(s)
- G. Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - L. Andrade
- Núcleo de Epidemiologia Psiquiátrica – LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C. Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - A. Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - R. Orozco
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J. C. Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Psychiatric Epidemiology Research Center (CEPEP), Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - M. E. Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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15
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Kohn R, Ali AA, Puac-Polanco V, Figueroa C, López-Soto V, Morgan K, Saldivia S, Vicente B. Mental health in the Americas: an overview of the treatment gap. Rev Panam Salud Publica 2018; 42:e165. [PMID: 31093193 PMCID: PMC6386160 DOI: 10.26633/rpsp.2018.165] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% - 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.
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Affiliation(s)
- Robert Kohn
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
| | - Ali Ahsan Ali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York, United States
| | - Victor Puac-Polanco
- Department of Epidemiology, Columbia University, New York, New York, United States
| | - Chantal Figueroa
- Global Heath Program, Colorado College, Colorado Springs, Colorado, United States
| | | | - Kristen Morgan
- Brown University School of Public Health, Providence, Rhode Island, United States
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Región del Bío Bío, Chile
| | - Benjamín Vicente
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Región del Bío Bío, Chile
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