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
Daniel Fernández
(1, 2)
,
Daniel Vigo
(3, 4)
,
Nancy Sampson
(4)
,
Irving Hwang
(4)
,
Sergio Aguilar-Gaxiola
(5)
,
Ali Al-Hamzawi
(6)
,
Jordi Alonso
(7, 8)
,
Laura Helena Andrade
(9)
,
Evelyn Bromet
(10)
,
Giovanni de Girolamo
(11)
,
Peter de Jonge
(12, 13)
,
Silvia Florescu
(14)
,
Oye Gureje
(15)
,
Hristo Hinkov
(16)
,
Chiyi Hu
(17)
,
Elie Karam
(18)
,
Georges Karam
(18)
,
Norito Kawakami
(19)
,
Andrzej Kiejna
(20)
,
Viviane Kovess-Masféty
(21)
,
Maria Medina-Mora
(22)
,
Fernando Navarro-Mateu
(23)
,
Akin Ojagbemi
(15)
,
Siobhan O'Neill
(24)
,
Marina Piazza
(25)
,
Jose Posada-Villa
(26)
,
Charlene Rapsey
(27)
,
David Williams
(28)
,
Miguel Xavier
(29)
,
Yuval Ziv
(30)
,
Ronald Kessler
(4)
,
Josep Haro
(1)
1
CIBERSAM -
Centro de Investigación Biomédica en Red de Salud Mental [Barcelona, Spain]
2 Open University of Catalonia [Barcelona]
3 UBC - University of British Columbia
4 HMS - Harvard Medical School [Boston]
5 UC Davis - University of California [Davis]
6 AL-Qadisiyah University
7 Hospital del Mar Medical Research Institute (IMIM)
8 UPF - Universitat Pompeu Fabra [Barcelona]
9 Universidade Federal de São Paulo
10 SBU - Stony Brook University [SUNY]
11 Istituto Centro San Giovanni di Dio Fatebenefratelli
12 Rijksuniversiteit Groningen
13 UMCG - University Medical Center Groningen [Groningen]
14 National School of Public Health, Management and Development
15 University College Hospital [Ibadan, Nigeria]
16 National Center of Public Health and Analyses
17 Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital
18 UOB - University of Balamand [Liban]
19 UTokyo - The University of Tokyo
20 Wrocław Medical University
21 EHESP - École des Hautes Études en Santé Publique [EHESP]
22 INPRF - National Institute of Psychiatry Ramón de la Fuente Muñiz [Mexico City]
23 Consejería de Sanidad de Murcia, Ciber de Epidemiologia y Salud Pública (CIBERESP)
24 University of Ulster
25 UPCH - Universidad Peruana Cayetano Heredia
26 Cundinamarca University
27 University of Otago [Dunedin, Nouvelle-Zélande]
28 Harvard T.H. Chan School of Public Health
29 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
30 Israeli Ministry of Health
2 Open University of Catalonia [Barcelona]
3 UBC - University of British Columbia
4 HMS - Harvard Medical School [Boston]
5 UC Davis - University of California [Davis]
6 AL-Qadisiyah University
7 Hospital del Mar Medical Research Institute (IMIM)
8 UPF - Universitat Pompeu Fabra [Barcelona]
9 Universidade Federal de São Paulo
10 SBU - Stony Brook University [SUNY]
11 Istituto Centro San Giovanni di Dio Fatebenefratelli
12 Rijksuniversiteit Groningen
13 UMCG - University Medical Center Groningen [Groningen]
14 National School of Public Health, Management and Development
15 University College Hospital [Ibadan, Nigeria]
16 National Center of Public Health and Analyses
17 Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital
18 UOB - University of Balamand [Liban]
19 UTokyo - The University of Tokyo
20 Wrocław Medical University
21 EHESP - École des Hautes Études en Santé Publique [EHESP]
22 INPRF - National Institute of Psychiatry Ramón de la Fuente Muñiz [Mexico City]
23 Consejería de Sanidad de Murcia, Ciber de Epidemiologia y Salud Pública (CIBERESP)
24 University of Ulster
25 UPCH - Universidad Peruana Cayetano Heredia
26 Cundinamarca University
27 University of Otago [Dunedin, Nouvelle-Zélande]
28 Harvard T.H. Chan School of Public Health
29 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
30 Israeli Ministry of Health
Giovanni de Girolamo
- Function : Author
- PersonId : 764102
- ORCID : 0000-0002-1611-8324
- IdRef : 03440242X
Oye Gureje
- Function : Author
- PersonId : 764103
- ORCID : 0000-0003-0094-5947
David Williams
- Function : Author
- PersonId : 775424
- ORCID : 0000-0003-4033-0867
Ronald Kessler
- Function : Author
- PersonId : 805399
- ORCID : 0000-0003-4831-2305
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.