Kings College London, Institute of Psychiatry, Psychology & Neuroscience,De Crespigny Park, London SE5 8AF,UK.
Center for Reducing Health Disparities, UC Davis Health System,Sacramento, California,USA.
Psychol Med. 2018 Jul;48(9):1560-1571. doi: 10.1017/S0033291717003336. Epub 2017 Nov 27.
The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.
Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).
The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
精神障碍患者人数与接受治疗人数之间的治疗差距是一个重大的公共卫生挑战。我们通过社会经济地位（SES；由家庭收入和受访者教育程度表示）和服务部门在跨国家社区流行病学调查数据中检查了这一差距。
数据来自世卫组织世界心理健康调查倡议中 25 个国家的社区调查中 16753 名患有 12 个月 DSM-IV 障碍的受访者。使用世界卫生组织复合国际诊断访谈（CIDI）评估 DSM-IV 焦虑、情绪或物质障碍以及这些障碍的治疗情况。
在中低收入国家，只有 13.7%的 12 个月 DSM-IV/CIDI 病例接受了治疗，在中上收入国家为 22.0%，在高收入国家为 36.8%。社会经济地位较高的受访者更有可能接受治疗，但这主要适用于专业心理健康治疗，其中与教育的相关性为正（受教育程度最高的受访者接受治疗的可能性最高，而其他受访者的教育与治疗之间的相关性较弱），但与收入的相关性是非单调的（中等收入受访者的治疗率略低，而高收入和低收入受访者的治疗率相当）。
教育与治疗的关联适度但更强，这引发了对 SES 与治疗之间的反比关系是由经济障碍引起的解释的质疑，尽管未来在考虑到背景因素的国家内分析可能会记录其他重要的具体情况。虽然超出了本报告的范围，但这种扩展分析可能对旨在增加社会经济弱势群体精神障碍治疗的干预措施的设计具有重要意义。
