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

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• dc.contributor.author Vigo, Daniel V.
• dc.contributor.author Alonso Caballero, Jordi
• dc.contributor.author Kessler, Ronald C.
• dc.date.accessioned 2023-03-22T07:13:39Z
• dc.date.available 2023-03-22T07:13:39Z
• dc.date.issued 2020
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Vigo D, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, Borges G et al. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder. Psychol Med. 2020;52(10):1948-58. DOI: 10.1017/S0033291720003797
• dc.identifier.doi http://dx.doi.org/10.1017/S0033291720003797
• dc.identifier.issn 0033-2917
• dc.identifier.uri http://hdl.handle.net/10230/56314
• dc.language.iso eng
• dc.publisher Cambridge University Press
• dc.relation.ispartof Psychol Med. 2020;52(10):1948-58
• dc.rights © Cambridge University Press. The published version of the article: Vigo D, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, Borges G et al. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder. Psychol Med. 2020 Oct 20:1-11. DOI: 10.1017/S0033291720003797 is available at http://dx.doi.org/10.1017/S0033291720003797.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword Effective coverage
• dc.subject.keyword Major depressive disorder
• dc.subject.keyword Pharmacotherapy
• dc.subject.keyword Psychotherapy
• dc.subject.keyword Treatment
• dc.title Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion