Little is known about the extent or severity of untreated mental disorders,
especially in less-developed countries.
To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed,
8 developed) in the World Health Organization (WHO) World Mental Health (WMH)
Design, Setting, and Participants
Face-to-face household surveys of 60 463 community adults conducted
from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa,
Main Outcome Measures
The DSM-IV disorders, severity, and treatment
were assessed with the WMH version of the WHO Composite International Diagnostic
Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic
The prevalence of having any WMH-CIDI/DSM-IV disorder
in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United
States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia)
and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious
disorders were associated with substantial role disability. Although disorder
severity was correlated with probability of treatment in almost all countries,
35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4%
in less-developed countries received no treatment in the 12 months before
the interview. Due to the high prevalence of mild and subthreshold cases,
the number of those who received treatment far exceeds the number of untreated
serious cases in every country.
Reallocation of treatment resources could substantially decrease the
problem of unmet need for treatment of mental disorders among serious cases.
Structural barriers exist to this reallocation. Careful consideration needs
to be given to the value of treating some mild cases, especially those at
risk for progressing to more serious disorders.