Authors
Dan J. Stein, Alan E. Kazdin, Richard J. Munthali, Irving Hwang, Meredith G. Harris, Jordi Alonso, Laura Helena Andrade, Ronny Bruffaerts, Graça Cardoso, Stephanie Chardoul, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Aimee N. Karam, Elie G. Karam, Viviane Kovess‑Masfety, Sing Lee, Maria Elena Medina‑Mora, Fernando Navarro‑Mateu, José Posada‑Villa, Juan Carlos Stagnaro, Margreet ten Have, Nancy A. Sampson, Ronald C. Kessler, Daniel V. Vigo and on behalf of the WHO World Mental Health Survey Collaborators
Abstract
Background:
Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).
Methods:
Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.
Results:
12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.
Conclusion:
There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.
Subject Area
Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys
Keywords
Posttraumatic stress disorder, Contact coverage, Effective treatment coverage, Insurance