Daniel Fernández1,2, Daniel Vigo3,4, Nancy A Sampson5, Irving Hwang5, Sergio Aguilar-Gaxiola6, Ali O Al-Hamzawi7, Jordi Alonso8,9,10, Laura Helena Andrade11, Evelyn J Bromet12, Giovanni de Girolamo13, Peter de Jonge14,15, Silvia Florescu16, Oye Gureje17, Hristo Hinkov18, Chiyi Hu19, Elie G Karam20,21, Georges Karam20,21, Norito Kawakami22, Andrzej Kiejna23, Viviane Kovess-Masfety24, Maria E Medina-Mora25, Fernando Navarro-Mateu26, Akin Ojagbemi17, Siobhan O'Neill27, Marina Piazza28, Jose Posada-Villa29, Charlene Rapsey30, David R Williams31, Miguel Xavier32, Yuval Ziv33, Ronald C Kessler5, Josep M Haro1. 1. Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain. 2. Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia-BarcelonaTech, Barcelona, Spain. 3. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. 4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. 5. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA. 6. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA. 7. College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq. 8. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. 9. CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. 10. Pompeu Fabra University (UPF), Barcelona, Spain. 11. Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 12. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA. 13. IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy. 14. Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands. 15. Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands. 16. National School of Public Health, Management and Development, Bucharest, Romania. 17. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. 18. National Center of Public Health and Analyses, Sofia, Bulgaria. 19. Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China. 20. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon. 21. Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. 22. Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan. 23. Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland. 24. Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France. 25. National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico. 26. UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain. 27. School of Psychology, Ulster University, Londonderry, United Kingdom. 28. Universidad Cayetano Heredia, Lima, Peru. 29. Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia. 30. Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 31. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 32. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal and. 33. Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel.
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.
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.
Authors: Louisa Degenhardt; Meyer Glantz; Sara Evans-Lacko; Ekaterina Sadikova; Nancy Sampson; Graham Thornicroft; Sergio Aguilar-Gaxiola; Ali Al-Hamzawi; Jordi Alonso; Laura Helena Andrade; Ronny Bruffaerts; Brendan Bunting; Evelyn J Bromet; José Miguel Caldas de Almeida; Giovanni de Girolamo; Silvia Florescu; Oye Gureje; Josep Maria Haro; Yueqin Huang; Aimee Karam; Elie G Karam; Andrzej Kiejna; Sing Lee; Jean-Pierre Lepine; Daphna Levinson; Maria Elena Medina-Mora; Yosikazu Nakamura; Fernando Navarro-Mateu; Beth-Ellen Pennell; José Posada-Villa; Kate Scott; Dan J Stein; Margreet Ten Have; Yolanda Torres; Zahari Zarkov; Somnath Chatterji; Ronald C Kessler Journal: World Psychiatry Date: 2017-10 Impact factor: 49.548
Authors: Koen Demyttenaere; Ronny Bruffaerts; Jose Posada-Villa; Isabelle Gasquet; Viviane Kovess; Jean Pierre Lepine; Matthias C Angermeyer; Sebastian Bernert; Giovanni de Girolamo; Pierluigi Morosini; Gabriella Polidori; Takehiko Kikkawa; Norito Kawakami; Yutaka Ono; Tadashi Takeshima; Hidenori Uda; Elie G Karam; John A Fayyad; Aimee N Karam; Zeina N Mneimneh; Maria Elena Medina-Mora; Guilherme Borges; Carmen Lara; Ron de Graaf; Johan Ormel; Oye Gureje; Yucun Shen; Yueqin Huang; Mingyuan Zhang; Jordi Alonso; Josep Maria Haro; Gemma Vilagut; Evelyn J Bromet; Semyon Gluzman; Charles Webb; Ronald C Kessler; Kathleen R Merikangas; James C Anthony; Michael R Von Korff; Philip S Wang; Traolach S Brugha; Sergio Aguilar-Gaxiola; Sing Lee; Steven Heeringa; Beth-Ellen Pennell; Alan M Zaslavsky; T Bedirhan Ustun; Somnath Chatterji Journal: JAMA Date: 2004-06-02 Impact factor: 56.272
Authors: Diane Warden; A John Rush; Thomas J Carmody; T Michael Kashner; Melanie M Biggs; M Lynn Crismon; Madhukar H Trivedi Journal: J Psychiatr Pract Date: 2009-03 Impact factor: 1.325
Authors: Meredith G Harris; Alan E Kazdin; Richard J Munthali; Daniel V Vigo; Irving Hwang; Nancy A Sampson; Ali Al-Hamzawi; Jordi Alonso; Laura Helena Andrade; Guilherme Borges; Brendan Bunting; Silvia Florescu; Oye Gureje; Elie G Karam; Sing Lee; Fernando Navarro-Mateu; Daisuke Nishi; Charlene Rapsey; Kate M Scott; Juan Carlos Stagnaro; Maria Carmen Viana; Bogdan Wojtyniak; Miguel Xavier; Ronald C Kessler Journal: Int J Ment Health Syst Date: 2022-01-29