Mental Illnesses Under-treated Compared With Physical Illnesses In High-, Low- And Middle-income Countries

Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 05 May 2008 - 3:00 PDT

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Despite often higher disability, mental illnesses are under-treated compared with physical illnesses in high-, low- and middle-income countries, a World Health Organisation study has found.

The aims of this 15-country study, published in the May issue of the British Journal of Psychiatry, were to establish the degree and type of disability, and level of treatment, of specific mental and physical disorders.

The World Health Organisation's World Mental Health Surveys were carried out in six countries classified by the World Bank as low- and middle-income (Colombia, Lebanon, People's Republic of China, South Africa, Ukraine) and nine as high-income (Belgium, France, The Netherlands, Germany, Italy, Spain, Japan, the USA and New Zealand).

The total sample size was 73,441, with individual country samples ranging from 2372 (The Netherlands) to 12,992 (New Zealand). The average response rate was 70.3%, with country-specific rates varying from 45.9% (France) to 87.7% (Colombia).

The commonly occurring physical disorders included in the surveys included asthma, cancer, heart disease, hypertension, diabetes, arthritis, back and neck pain, chronic headaches, other chronic pain disorders and stomach ulcers.

The mental disorders studied included anxiety disorders, such as panic disorder, social phobia and post-traumatic stress disorder; mood disorders, such as depression and bipolar disorder; and impulse-control disorders, such as adult attention deficit hyperactivity disorder and intermittent explosive disorder.

The researchers measured treatment sought and received for both types of disorder, and assessed the level and type of disability attributed to them by respondents. The four disability areas explored were home management, ability to work, social life and close personal relationships.

Four key findings emerged from the analyses:

1. Respondents generally attributed more disability to their mental than to their physical disorder

2. The higher disability of mental compared with physical disorders held as strongly in low- and middle-income countries as in high-income countries

3. The higher level of disability associated with mental disorder compared with physical disorder was much more pronounced for disability in social and personal relationships than in productive roles, such as work and housework

4. The proportion of people receiving treatment at the time of interview was much lower for mental than for physical disorders in high-income countries, and even more so in low- and middle-income countries. This finding applied both to the total sample and also to participants rated as having a severely disabling disorder.

These results are consistent with previous comparative burden-of-illness studies in suggesting that musculoskeletal disorders and major depression are the most disabling disorders across the socioeconomic spectrum. Previous studies have documented this pattern only for the USA, although World Mental Health Surveys have also highlighted the importance of depression.

The researchers comment that these new results imply that mental disorders are disabling more because they create psychological barriers rather than physical barriers to functioning. Among these barriers are limitations in cognitive and motivational capacity, regulation of feelings, embarrassment and stigma.

Disability in productive role functioning, such as work and home management, was generally comparable for mental and physical disorders.

Given this greater disability of mental than physical disorders, it is disturbing to find that only a minority of people with severe mental disorders receive treatment, and that treatment is substantially more common for severe physical disorders, the researchers say.

Combined with the burden of disability that mental disorders produce, the low treatment rates call for more attention to be paid to mental disorders, they believe. Treatment effectiveness trials show that common anxiety and mood disorders can often be successfully treated, although long-term outcomes are more uncertain and further research is needed.

Despite this uncertainty, the findings of this study strongly imply that more attention should be given to the treatment of mental disorders, particularly in middle- and low- income countries.

"Disability and treatment of specific mental and physical disorders across the world."
Kessler R. C. et al (2008)
British Journal of Psychiatry 192, 5, pages 368-375
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The Royal College of Psychiatrists

The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland. We promote mental health by:

-- Setting standards and promoting excellence in mental health care
-- Improving understanding through research and education
-- Leading, representing, training and supporting psychiatrists
-- Working with patients, carers and their organisations

As well as running its membership examination (MRCPsych), and visiting and approving hospitals for training purposes, the College organises scientific and clinical conferences and lectures and continuing professional development activities. The College publishes books, reports and educational material for professionals and the general public. It also publishes the British Journal of Psychiatry, Psychiatric Bulletin and Advances in Psychiatric Treatment, all of which are now available on-line.

The Royal College of Psychiatrists has been in existence in some form since 1841. First as the "Association of Medical Officers of Asylums and Hospitals for the Insane" (later changed to the Medico Psychological Association) then, in 1926 receiving its Royal Charter to become the "Royal Medico Psychological Association, and finally, in 1971 receiving a Supplemental Charter to become the "Royal College of Psychiatrists" we know today.

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