Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
Epidemiol Psychiatr Sci. 2019 Aug 27;29:e53. doi: 10.1017/S2045796019000477.
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.
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.
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.
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.
为美洲部分国家提供关于精神和物质使用障碍的服务利用情况、这些服务在治疗领域中的分布、治疗充分性以及与心理健康治疗和治疗充分性相关的因素的跨国数据。
数据来自于对来自七个国家（北美的美国、中美的墨西哥和南美的阿根廷、巴西、哥伦比亚和秘鲁）的 6710 名患有 12 个月精神障碍的成年人进行的 12 个月精神障碍调查的数据，这些成年人在 2001 年至 2015 年期间接受了世界卫生组织（WHO）世界心理健康（WMH）调查的采访。DSM-IV 诊断是通过世界卫生组织综合国际诊断访谈（CIDI）做出的。访谈还评估了治疗部门的服务利用情况、接受治疗的充分性以及社会人口统计学相关因素。
略多于四分之一的受访者患有任何 12 个月 DSM-IV/CIDI 障碍，但只有不到四分之一的人接受了任何治疗。尽管绝大多数（87.1%）治疗是最低限度充分的，但只有 35.3%的病例接受了符合可接受质量标准的治疗。社会优势的指标（高教育和收入）与更高的服务利用和充分性相关，但其他一些相关因素在不同的调查地点有所不同。
这些结果揭示了一个涉及常见精神障碍治疗不足的巨大公共卫生问题，尽管这个问题在社会劣势人群中最为严重。迫切需要推广更易获得的服务，特别是针对那些资源较少的人。
