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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

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
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.
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https://hal.ehesp.fr/hal-03124049
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Submitted on : Thursday, January 28, 2021 - 1:06:10 PM
Last modification on : Tuesday, January 25, 2022 - 6:56:08 PM

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Daniel Fernández, Daniel Vigo, Nancy Sampson, Irving Hwang, Sergio Aguilar-Gaxiola, et al.. 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. Psychological Medicine, Cambridge University Press (CUP), 2020, pp.1-13. ⟨10.1017/S0033291720000884⟩. ⟨hal-03124049⟩

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