Wang Philip S, Aguilar-Gaxiola Sergio, Alonso Jordi, Angermeyer Matthias C, Borges Guilherme, Bromet Evelyn J, Bruffaerts Ronny, de Girolamo Giovanni, de Graaf Ron, Gureje Oye, Haro Josep Maria, Karam Elie G, Kessler Ronald C, Kovess Viviane, Lane Michael C, Lee Sing, Levinson Daphna, Ono Yutaka, Petukhova Maria, Posada-Villa José, Seedat Soraya, Wells J Elisabeth
Division of Services and Intervention Research, National Institute of Mental Health, Rockville, MD, USA.
Lancet. 2007 Sep 8;370(9590):841-50. doi: 10.1016/S0140-6736(07)61414-7.
Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment.
Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services.
The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less.
Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
精神障碍是全球致残的主要原因，在最无力承担此类负担的低收入和中等收入国家亦是如此。我们描述了参与世界卫生组织世界精神卫生（WMH）调查倡议的17个国家的精神卫生保健情况，并研究了未满足的治疗需求。
对低收入或中等收入国家（哥伦比亚、黎巴嫩、墨西哥、尼日利亚、中国、南非、乌克兰）和高收入国家（比利时、法国、德国、以色列、意大利、日本、荷兰、新西兰、西班牙、美国）的84850名社区成年受访者进行了面对面的家庭调查。采用WMH综合国际诊断访谈评估了12个月内精神障碍的患病率和严重程度以及精神卫生服务的使用情况。使用逻辑回归分析来研究接受任何12个月服务的社会人口学预测因素。
在12个月内使用任何精神卫生服务的受访者数量（从57人[2%；尼日利亚]到1477人[18%；美国]）在发展中国家普遍低于发达国家，接受服务的比例往往与各国医疗保健支出占国内生产总值的百分比相对应。尽管疾病的严重程度与服务使用有关，但在上一年，只有5名（11%；中国）至46名（61%；比利时）严重疾病患者接受了任何治疗。普通医疗部门是精神卫生服务的最大来源。对于开始治疗的受访者，152名（70%；德国）至129名（95%；意大利）接受了任何后续护理，1名（10%；尼日利亚）至113名（42%；法国）接受了符合最低充分标准的治疗。男性、已婚、受教育程度较低以及年龄或收入处于极端水平的患者接受治疗的情况较少。
精神卫生治疗的未满足需求普遍存在，在欠发达国家尤其令人担忧。缓解这些未满足的需求将需要扩大治疗资源并进行优化分配。
