Publicação

Determinants of effective treatment coverage for posttraumatic stress disorder

Detalhes bibliográficos
Resumo:	Background: Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs). Methods: Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage. Results: 12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR =.35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage. Conclusion: There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.
Autores principais:	Stein, Dan J.
Outros Autores:	Kazdin, Alan E.; Munthali, Richard J.; Hwang, Irving; Harris, Meredith G.; Alonso, Jordi; Andrade, Laura Helena; Bruffaerts, Ronny; Cardoso, Graça; Cardoso, Graca; Chardoul, Stephanie; de Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; Haro, Josep Maria; Karam, Aimee Nasser; Karam, Elie G.; Kovess-Masfety, Viviane; Lee, Sing; Medina-Mora, Maria Elena; Navarro-Mateu, Fernando; Posada-Villa, José; Stagnaro, Juan Carlos; ten Have, Margreet; Sampson, Nancy A.; Kessler, Ronald C.; Kessler, Ronald; Vigo, Daniel V.; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Altwaijri, Yasmin A.; Atwoli, Lukoye; Benjet, Corina; Borges, Guilherme; Bromet, Evelyn J.; Bunting, Brendan; Caldas-de-Almeida, Jose Miguel; JM, Caldas-de-Almeida; Chatterji, Somnath; Cia, Alfredo H.; Degenhardt, Louisa; Demyttenaere, Koen; Hinkov, Hristo; Hu, Chi yi; de Jonge, Peter; Karam, Aimee Nasser; Karam, Georges; Kawakami, Norito; Kiejna, Andrzej; Lepine, Jean Pierre; McGrath, John J.; Moskalewicz, Jacek; Piazza, Marina
Assunto:	Contact coverage Effective treatment coverage Insurance Posttraumatic stress disorder Psychiatry and Mental health SDG 3 - Good Health and Well-being
Ano:	2023
País:	Portugal
Tipo de documento:	artigo
Tipo de acesso:	acesso aberto
Instituição associada:	Universidade Nova de Lisboa
Idioma:	inglês
Origem:	Repositório Institucional da UNL

Descrição
Resumo:	Background: Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs). Methods: Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage. Results: 12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR =.35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage. Conclusion: There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.