21个国家中重度抑郁症患者的治疗不足。
Undertreatment of people with major depressive disorder in 21 countries.
作者信息
Thornicroft Graham, Chatterji Somnath, Evans-Lacko Sara, Gruber Michael, Sampson Nancy, Aguilar-Gaxiola Sergio, Al-Hamzawi Ali, Alonso Jordi, Andrade Laura, Borges Guilherme, Bruffaerts Ronny, Bunting Brendan, de Almeida Jose Miguel Caldas, Florescu Silvia, de Girolamo Giovanni, Gureje Oye, Haro Josep Maria, He Yanling, Hinkov Hristo, Karam Elie, Kawakami Norito, Lee Sing, Navarro-Mateu Fernando, Piazza Marina, Posada-Villa Jose, de Galvis Yolanda Torres, Kessler Ronald C
机构信息
Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Br J Psychiatry. 2017 Feb;210(2):119-124. doi: 10.1192/bjp.bp.116.188078. Epub 2016 Dec 1.
BACKGROUND
Major depressive disorder (MDD) is a leading cause of disability worldwide.
AIMS
To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.
METHOD
Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.
RESULTS
Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.
CONCLUSIONS
Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
背景
重度抑郁症（MDD）是全球致残的主要原因。
目的
研究：（a）DSM-IV重度抑郁症的12个月患病率；（b）意识到自己有问题需要治疗且希望获得护理的比例；（c）后者接受治疗的比例；以及（d）此类治疗达到最低标准的比例。
方法
作为世界卫生组织世界心理健康调查的一部分，对21个国家具有代表性的社区家庭进行调查。
结果
在51547名受访者中，4.6%符合DSM-IV重度抑郁症的12个月标准，其中56.7%报告需要治疗。在那些认识到自己需要治疗的人中，大多数（71.1%）至少去看过一次服务提供者。在接受治疗的人中，只有41.0%接受了符合最低标准的治疗。这导致所有患有12个月重度抑郁症的人中只有16.5%接受了最低限度的充分治疗。
结论
只有少数患有重度抑郁症的参与者接受了最低限度的充分治疗：高收入国家每5人中有1人，低收入/中低收入国家每27人中有1人。扩大对重度抑郁症的护理需要在社区教育和外展、治疗供应和服务质量方面进行根本性变革。
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