Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

on behalf of the WHO World Mental Health Survey Collaborators; 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; Sergio Aguilar-Gaxiola; Ali Al-Hamzawi; Yasmin A. Altwaijri; Lukoye Atwoli; Corina Benjet; Guilherme Borges; Evelyn J. Bromet; Brendan Bunting; Jose Miguel Caldas-de-Almeida; Somnath Chatterji; Alfredo H. Cia; Louisa Degenhardt; Koen Demyttenaere; Hristo Hinkov; Chi yi Hu; Peter de Jonge; Aimee Nasser Karam; Georges Karam; Norito Kawakami; Andrzej Kiejna; Jean Pierre Lepine; John J. McGrath; Jacek Moskalewicz; David R. Williams

doi:10.1186/s12888-023-04605-2

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

on behalf of the WHO World Mental Health Survey Collaborators, 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-MoraFernando Navarro-Mateu, José Posada-Villa, Juan Carlos Stagnaro, Margreet ten Have, Nancy A. Sampson, Ronald C. Kessler, Daniel V. Vigo, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Yasmin A. Altwaijri, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Somnath Chatterji, Alfredo H. Cia, Louisa Degenhardt, Koen Demyttenaere, Hristo Hinkov, Chi yi Hu, Peter de Jonge, Aimee Nasser Karam, Georges Karam, Norito Kawakami, Andrzej Kiejna, Jean Pierre Lepine, John J. McGrath, Jacek Moskalewicz, David R. Williams

^*Corresponding author for this work

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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.

Original language	English
Article number	226
Number of pages	12
Journal	BMC Psychiatry
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12888-023-04605-2
Publication status	Published - Dec-2023

Keywords

Contact coverage
Effective treatment coverage
Insurance
Posttraumatic stress disorder

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on behalf of the WHO World Mental Health Survey Collaborators, Stein, D. J., Kazdin, A. E., Munthali, R. J., Hwang, I., Harris, M. G., Alonso, J., Andrade, L. H., Bruffaerts, R., Cardoso, G., Chardoul, S., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Karam, A. N., Karam, E. G., Kovess-Masfety, V., Lee, S., ... Williams, D. R. (2023). Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys. BMC Psychiatry, 23(1), Article 226. https://doi.org/10.1186/s12888-023-04605-2

@article{bb272e51bbc644b19a92bd32d8cc6dba,

title = "Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys",

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.",

keywords = "Contact coverage, Effective treatment coverage, Insurance, Posttraumatic stress disorder",

author = "{on behalf of the WHO World Mental Health Survey Collaborators} and Stein, {Dan J.} and Kazdin, {Alan E.} and Munthali, {Richard J.} and Irving Hwang and Harris, {Meredith G.} and Jordi Alonso and Andrade, {Laura Helena} and Ronny Bruffaerts and Gra{\c c}a Cardoso and Stephanie Chardoul and {de Girolamo}, Giovanni and Silvia Florescu and Oye Gureje and Haro, {Josep Maria} and Karam, {Aimee N.} and Karam, {Elie G.} and Viviane Kovess-Masfety and Sing Lee and Medina-Mora, {Maria Elena} and Fernando Navarro-Mateu and Jos{\'e} Posada-Villa and Stagnaro, {Juan Carlos} and {ten Have}, Margreet and Sampson, {Nancy A.} and Kessler, {Ronald C.} and Vigo, {Daniel V.} and Sergio Aguilar-Gaxiola and Ali Al-Hamzawi and Altwaijri, {Yasmin A.} and Lukoye Atwoli and Corina Benjet and Guilherme Borges and Bromet, {Evelyn J.} and Brendan Bunting and Caldas-de-Almeida, {Jose Miguel} and Somnath Chatterji and Cia, {Alfredo H.} and Louisa Degenhardt and Koen Demyttenaere and Hristo Hinkov and Hu, {Chi yi} and {de Jonge}, Peter and Karam, {Aimee Nasser} and Georges Karam and Norito Kawakami and Andrzej Kiejna and Lepine, {Jean Pierre} and McGrath, {John J.} and Jacek Moskalewicz and Williams, {David R.}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s12888-023-04605-2",

language = "English",

volume = "23",

journal = "BMC Psychiatry",

issn = "1471-244X",

publisher = "BMC",

number = "1",

}

on behalf of the WHO World Mental Health Survey Collaborators, Stein, DJ, Kazdin, AE, Munthali, RJ, Hwang, I, Harris, MG, Alonso, J, Andrade, LH, Bruffaerts, R, Cardoso, G, Chardoul, S, de Girolamo, G, Florescu, S, Gureje, O, Haro, JM, Karam, AN, Karam, EG, Kovess-Masfety, V, Lee, S, Medina-Mora, ME, Navarro-Mateu, F, Posada-Villa, J, Stagnaro, JC, ten Have, M, Sampson, NA, Kessler, RC, Vigo, DV, Aguilar-Gaxiola, S, Al-Hamzawi, A, Altwaijri, YA, Atwoli, L, Benjet, C, Borges, G, Bromet, EJ, Bunting, B, Caldas-de-Almeida, JM, Chatterji, S, Cia, AH, Degenhardt, L, Demyttenaere, K, Hinkov, H, Hu, CY, de Jonge, P, Karam, AN, Karam, G, Kawakami, N, Kiejna, A, Lepine, JP, McGrath, JJ, Moskalewicz, J & Williams, DR 2023, 'Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys', BMC Psychiatry, vol. 23, no. 1, 226. https://doi.org/10.1186/s12888-023-04605-2

TY - JOUR

T1 - Determinants of effective treatment coverage for posttraumatic stress disorder

T2 - findings from the World Mental Health Surveys

AU - on behalf of the WHO World Mental Health Survey Collaborators

AU - Stein, Dan J.

AU - Kazdin, Alan E.

AU - Munthali, Richard J.

AU - Hwang, Irving

AU - Harris, Meredith G.

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Bruffaerts, Ronny

AU - Cardoso, Graça

AU - Chardoul, Stephanie

AU - de Girolamo, Giovanni

AU - Florescu, Silvia

AU - Gureje, Oye

AU - Haro, Josep Maria

AU - Karam, Aimee N.

AU - Karam, Elie G.

AU - Kovess-Masfety, Viviane

AU - Lee, Sing

AU - Medina-Mora, Maria Elena

AU - Navarro-Mateu, Fernando

AU - Posada-Villa, José

AU - Stagnaro, Juan Carlos

AU - ten Have, Margreet

AU - Sampson, Nancy A.

AU - Kessler, Ronald C.

AU - Vigo, Daniel V.

AU - Aguilar-Gaxiola, Sergio

AU - Al-Hamzawi, Ali

AU - Altwaijri, Yasmin A.

AU - Atwoli, Lukoye

AU - Benjet, Corina

AU - Borges, Guilherme

AU - Bromet, Evelyn J.

AU - Bunting, Brendan

AU - Caldas-de-Almeida, Jose Miguel

AU - Chatterji, Somnath

AU - Cia, Alfredo H.

AU - Degenhardt, Louisa

AU - Demyttenaere, Koen

AU - Hinkov, Hristo

AU - Hu, Chi yi

AU - de Jonge, Peter

AU - Karam, Aimee Nasser

AU - Karam, Georges

AU - Kawakami, Norito

AU - Kiejna, Andrzej

AU - Lepine, Jean Pierre

AU - McGrath, John J.

AU - Moskalewicz, Jacek

AU - Williams, David R.

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

KW - Contact coverage

KW - Effective treatment coverage

KW - Insurance

KW - Posttraumatic stress disorder

UR - http://www.scopus.com/inward/record.url?scp=85152686505&partnerID=8YFLogxK

U2 - 10.1186/s12888-023-04605-2

DO - 10.1186/s12888-023-04605-2

M3 - Article

AN - SCOPUS:85152686505

SN - 1471-244X

VL - 23

JO - BMC Psychiatry

JF - BMC Psychiatry

IS - 1

M1 - 226

ER -

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

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