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Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative

Published online by Cambridge University Press:  28 April 2020

Daniel Fernández Open the ORCID record for Daniel Fernández [Opens in a new window] ,
Daniel Vigo ,
Nancy A. Sampson ,
Irving Hwang ,
Sergio Aguilar-Gaxiola ,
Ali O. Al-Hamzawi ,
Jordi Alonso ,
Laura Helena Andrade ,
Evelyn J. Bromet  and
Giovanni de Girolamo
...Show all authors
Daniel Fernández
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia-BarcelonaTech, Barcelona, Spain
Daniel Vigo
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Irving Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Sergio Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
Ali O. Al-Hamzawi
Affiliation:
College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
Jordi Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Spain Pompeu Fabra University (UPF), Barcelona, Spain
Laura Helena Andrade
Affiliation:
Núcleo de Epidemiologia Psiquiátrica – LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Evelyn J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
Giovanni de Girolamo
Affiliation:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Peter de Jonge
Affiliation:
Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
Silvia Florescu
Affiliation:
National School of Public Health, Management and Development, Bucharest, Romania
Oye Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Hristo Hinkov
Affiliation:
National Center of Public Health and Analyses, Sofia, Bulgaria
Chiyi Hu
Affiliation:
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
Elie G. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Georges Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Norito Kawakami
Affiliation:
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
Andrzej Kiejna
Affiliation:
Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland
Viviane Kovess-Masfety
Affiliation:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Maria E. Medina-Mora
Affiliation:
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Fernando Navarro-Mateu
Affiliation:
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
Akin Ojagbemi
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Siobhan O'Neill
Affiliation:
School of Psychology, Ulster University, Londonderry, United Kingdom
Marina Piazza
Affiliation:
Universidad Cayetano Heredia, Lima, Peru
Jose Posada-Villa
Affiliation:
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Charlene Rapsey
Affiliation:
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
David R. Williams
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Miguel Xavier
Affiliation:
NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal and
Yuval Ziv
Affiliation:
Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
Ronald C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Josep M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
*
Author for correspondence: Ronald C. Kessler, E-mail: Kessler@hcp.med.harvard.edu
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Abstract

Background

There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.

Methods

Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.

Results

Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.

Conclusions

Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

Keywords

Dropoutmental healthsurvival analysisWMH surveys
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 12 , September 2021 , pp. 2104 - 2116
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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