The Treatment Gap in Mental Health Care

By Kohn, Robert; Saxena, Shekhar et al. | Bulletin of the World Health Organization, November 2004 | Go to article overview

The Treatment Gap in Mental Health Care


Kohn, Robert, Saxena, Shekhar, Levav, Itzhak, Saraceno, Benedetto, Bulletin of the World Health Organization


Resume

Le defaut de traitement en sante mentale

Les troubles mentaux ont une prevalence elevee et representent une charge considerable en termes de souffrance et de maladie. De plus, de nombreuses personnes atteintes de troubles psychiques restent sans traitement alors qu'il en existe d'efficaces. Dans le present article, nous examinons I'etendue de ce defaut de traitement. Nous avons effectue une revue des etudes epidemiologiques psychiatriques en population utilisant des outils de diagnostic standard et comportant des donnees sur le pourcentage de sujets traites pour schizophrenie et autres troubles psychotiques non affectifs, depression majeure, dysthymie, trouble bipolaire, anxiete generalisee, trouble panique, troubles obsessionnels-compulsifs (TOC) et abus d'alcool ou dependance alcoolique. Les taux medians d'absence de traitement de ces affections ont ete calcules pour I'ensemble de ces etudes. L'article presente egalement des exemples d'estimations du defaut de traitement dans les Regions OMS. Le taux median de defaut de traitement pour la schizophrenie, y compris les autres psychoses non affectives, etait de 32,2 %. Pour les autres affections il etait de : depression 56,3 %, dysthymie 56,0 %, trouble bipolaire 50,2 %, trouble panique 55,9 %, anxiete generalisee 57,5 % et TOC 57,3 %. Il etait maximal pour I'abus d'alcool et la dependance alcoolique avec 78,1%. Le taux de defaut de traitement des troubles mentaux est eleve partout, meme s'il varie d'une region I'autre. Il est probable que les taux rapportes ici sont en-deca de la realite, du fait de I'absence de donnees concernant les pays en developpement, ou les services de sante mentale sont plus rares. Pour repondre a cet important probleme de sante publique, I'OMS a adopte en 2002 un programme mondial d'action, qui a ete approuve par les Etats Membres.

Resumen

La brecha terapeutica en la atencion de salud mental

Los trastornos mentales, cuya prevalencia es muy alta, son una causa destacada de sufrimiento y morbilidad. Este problema de salud publica se ve agravado por el hecho de que muchos individuos aquejados de trastornos psiquiatricos no reciben tratamiento alguno pese a que existen intervenciones eficaces. Hemos analizado la magnitud de esa brecha terapeutica, para Io cual se han examinado estudios comunitarios de epidemiologia psiquiatrica que habian usado instrumentos diagnosticos normalizados e incluian datos sobre el porcentaje de individuos que recibian atencion por padecer esquizofrenia y otros trastornos psicoticos no afectivos, depresion grave, distimia, trastorno bipolar, trastorno de ansiedad generalizado, trastorno de panico, trastorno obsesivo-compulsivo (TOC) y abuso o dependencia del alcohol. Se calcularon las tasas medianas de casos sin tratar de esos trastornos en el conjunto de todos los estudios. Se presentan asimismo ejemplos de estimaciones de la brecha terapeutica para las Regiones de la OMS. En 37 estudios se facilitaba informaci6n sobre la utilizacion de los servicios. La brecha terapeutica mediana para la esquizofrenia, incluidas otras psicosis no afectivas, fue del 32,2%. Las brechas medidas para los otros trastornos fueron las siguientes: depresion, 56,3%; distimia, 56,0%; trastorno bipolar, 50,2%; trastorno de panico, 55,9%; ansiedad generalizada, 57,5%, y TOC, 57,3%. La brecha mas importante rue la correspondiente al abuso y la dependencia del alcohol, 78,1%. La brecha terapeutica de los trastornos mentales es muy amplia en general, aunque varia entre las regiones. Es probable que los valores aqui presentados subestimen la realidad, debido a la falta de datos comunitarios de los paises en desarrollo donde mas escasean los servicios. Para afrontar este importante reto de salud publica, la OMS ha adoptado en 2002 un programa mundial de accion que ha sido respaldado por los Estados Miembros.

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Introduction

The care of people with mental and brain disorders is a growing public health concern. …

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