Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD an...

Descripción completa

Detalles Bibliográficos
Autores: Vigo D, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, Borges G, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Karam E, Karam G, Kovess-Masfety V, Lee S, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson NA, Scott K, Stagnaro JC, Ten Have M, Viana MC, Wu CS, Chatterji S, Cuijpers P, Thornicroft G, Kessler RC
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Fundació Sant Joan de Déu
Repositorio:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p18374
Acceso en línea:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=18374
Access Level:acceso abierto
Palabra clave:Effective coverage
major depressive disorder
pharmacotherapy
psychotherapy
treatment
id ES_ce647858aa433eb04496c3b1ddbfce6c
oai_identifier_str oai:fsjd.fundanetsuite.com:p18374
network_acronym_str ES
network_name_str España
repository_id_str
spelling Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.Vigo DHaro JMHwang IAguilar-Gaxiola SAlonso JBorges GBruffaerts RCaldas-de-Almeida JMde Girolamo GFlorescu SGureje OKaram EKaram GKovess-Masfety VLee SNavarro-Mateu FOjagbemi APosada-Villa JSampson NAScott KStagnaro JCTen Have MViana MCWu CSChatterji SCuijpers PThornicroft GKessler RCEffective coveragemajor depressive disorderpharmacotherapypsychotherapytreatmentBACKGROUND: Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. METHODS: Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. RESULTS: MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. CONCLUSIONS: Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.CAMBRIDGE UNIV PRESS2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=18374PSYCHOLOGICAL MEDICINEISSN: 00332917ISSNe: 14698978reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:fsjd.fundanetsuite.com:p183742026-05-27T12:37:41Z
dc.title.none.fl_str_mv Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
title Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
spellingShingle Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
Vigo D
Effective coverage
major depressive disorder
pharmacotherapy
psychotherapy
treatment
title_short Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
title_full Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
title_fullStr Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
title_full_unstemmed Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
title_sort Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.
dc.creator.none.fl_str_mv Vigo D
Haro JM
Hwang I
Aguilar-Gaxiola S
Alonso J
Borges G
Bruffaerts R
Caldas-de-Almeida JM
de Girolamo G
Florescu S
Gureje O
Karam E
Karam G
Kovess-Masfety V
Lee S
Navarro-Mateu F
Ojagbemi A
Posada-Villa J
Sampson NA
Scott K
Stagnaro JC
Ten Have M
Viana MC
Wu CS
Chatterji S
Cuijpers P
Thornicroft G
Kessler RC
author Vigo D
author_facet Vigo D
Haro JM
Hwang I
Aguilar-Gaxiola S
Alonso J
Borges G
Bruffaerts R
Caldas-de-Almeida JM
de Girolamo G
Florescu S
Gureje O
Karam E
Karam G
Kovess-Masfety V
Lee S
Navarro-Mateu F
Ojagbemi A
Posada-Villa J
Sampson NA
Scott K
Stagnaro JC
Ten Have M
Viana MC
Wu CS
Chatterji S
Cuijpers P
Thornicroft G
Kessler RC
author_role author
author2 Haro JM
Hwang I
Aguilar-Gaxiola S
Alonso J
Borges G
Bruffaerts R
Caldas-de-Almeida JM
de Girolamo G
Florescu S
Gureje O
Karam E
Karam G
Kovess-Masfety V
Lee S
Navarro-Mateu F
Ojagbemi A
Posada-Villa J
Sampson NA
Scott K
Stagnaro JC
Ten Have M
Viana MC
Wu CS
Chatterji S
Cuijpers P
Thornicroft G
Kessler RC
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Effective coverage
major depressive disorder
pharmacotherapy
psychotherapy
treatment
topic Effective coverage
major depressive disorder
pharmacotherapy
psychotherapy
treatment
description BACKGROUND: Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. METHODS: Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. RESULTS: MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. CONCLUSIONS: Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=18374
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=18374
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv CAMBRIDGE UNIV PRESS
publisher.none.fl_str_mv CAMBRIDGE UNIV PRESS
dc.source.none.fl_str_mv PSYCHOLOGICAL MEDICINE
ISSN: 00332917
ISSNe: 14698978
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
collection r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869419986825510912
score 15,812455

Similares en LA Referencia