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Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys

Published online by Cambridge University Press:  27 November 2017

S. Evans-Lacko
Kings College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK PSSRU, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
S. Aguilar-Gaxiola
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
A. Al-Hamzawi
College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
J. Alonso
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
C. Benjet
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico
R. Bruffaerts
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
W. T. Chiu
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
S. Florescu
National School of Public Health, Management and Development, Bucharest, Romania
G. de Girolamo
Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
O. Gureje
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
J. M. Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Y. He
Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
C. Hu
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
E. G. Karam
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
N. Kawakami
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
S. Lee
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
C. Lund
Kings College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
V. Kovess-Masfety
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
D. Levinson
Mental Health Services, Ministry of Health, Jerusalem, Israel
F. Navarro-Mateu
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
B. E. Pennell
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
N. A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
K. M. Scott
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
H. Tachimori
National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
M. ten Have
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
M. C. Viana
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
D. R. Williams
Department of Society, Human Development, and Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
B. J. Wojtyniak
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
Z. Zarkov
Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
R. C. Kessler*
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
S. Chatterji
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
Author for correspondence: R. C. Kessler, E-mail:



The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.


Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).


Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).


The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.

Original Articles
Copyright © Cambridge University Press 2017 

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