The British Journal of Psychiatry (2008) 192: 368-375. doi: 10.1192/bjp.bp.107.039107
© 2008 The Royal College of Psychiatrists
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Disability and treatment of specific mental and physical disorders across the world

Johan Ormel, PhD

Department of Psychiatry & Department of Epidemiology and Bioinformatics, University Medical Center Groningen, and Graduate School of Behavioural and Cognitive Neurosciences & Graduate School for Experimental Psychopathology, University of Groningen, The Netherlands

Maria Petukhova, PhD

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Somnath Chatterji, MD

Measurement and Health Information Systems Unit, World Health Organization, Geneva, Switzerland

Sergio Aguilar-Gaxiola, MD, PhD

Center for Reducing Health Disparities, University of California Davis, California, USA

Jordi Alonso, MD, PhD

Health Services Research Unit, Institut Municipal d’Investigacio Medica, Barcelona, Spain

Matthias C. Angermeyer, MD

University of Leipzig, Department of Psychiatry, Germany

Evelyn J. Bromet, PhD

SUNY Stony Brook, New York, USA

Huibert Burger, MD, PhD

Department of Psychiatry & Department of Epidemiology and Bioinformatics, University Medical Center Groningen, and Graduate School of Behavioural and Cognitive Neurosciences & Graduate School for Experimental Psychopathology, University of Groningen, The Netherlands

Koen Demyttenaere, MD, PhD

University Hospital, Gasthuisberg, Leuven, Belgium

Giovanni de Girolamo, MD

Department of Mental Health, AUSL di Bologna, Italy

Josep Maria Haro, MD, MPH, PhD

Sant Joan de Deu-SSM, Barcelona, Spain

Irving Hwang, MPH

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Elie Karam, MD

Department of Psychiatry and Psychology, St George Hospital University Medical Center, and Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Lebanon

Norito Kawakami, MD

Department of Mental Health, University of Tokyo Graduate School of Medicine, Tokyo, Japan

Jean Pierre Lépine, MD

Hospital Fernand Widal, Paris, France

María Elena Medina-Mora, PhD

Division of Epidemiological and Social Research, Mexican Institute of Psychiatry, Mexico City, Mexico

José Posada-Villa, MD

Colegio Mayor de Cundinamarca University, Saldarriaga Concha Foundation, Colombia

Nancy Sampson, BA

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Kate Scott, PhD

Wellington School of Medicine and Health Sciences, Otago University, New Zealand

T. Bedirhan Üstün, MD

Classifications and Terminology Unit, World Health Organization, Geneva, Switzerland

Michael Von Korff, ScD

Center for Health Studies, Group Health Cooperative, Seattle, USA

David R. Williams, PhD, MPH

Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA

Mingyuan Zhang, MD

Shanghai Mental Health Center, Shanghai, China

Ronald C. Kessler, PhD

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Correspondence: Ronald C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, 02115, USA. Email: kessler{at}hcp.med.harvard.edu

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Advocates of expanded mental health treatment assert that mental disorders are as disabling as physical disorders, but little evidence supports this assertion.

Aims

To establish the disability and treatment of specific mental and physical disorders in high-income and low- and middle-income countries.

Method

Community epidemiological surveys were administered in 15 countries through the World Health Organization World Mental Health (WMH) Survey Initiative.

Results

Respondents in both high-income and low- and middle-income countries attributed higher disability to mental disorders than to the commonly occurring physical disorders included in the surveys. This pattern held for all disorders and also for treated disorders. Disaggregation showed that the higher disability of mental than physical disorders was limited to disability in social and personal role functioning, whereas disability in productive role functioning was generally comparable for mental and physical disorders.

Conclusions

Despite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.


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