Reconceptualising the treatment gap for common mental disorders: a fork in the road for global mental health?

Roberts, Tessa; Esponda, Georgina Miguel; Torre, Costanza; Pillai, Pooja; Cohen, Alex; Burgess, Rochelle

doi:10.1192/bjp.2021.221

Cited by 23 publications

(30 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent systematic review exploring the impact of socio-economic status (SES) on anti-depressant treatment outcomes highlighted that lower SES could lead to differential outcomes, even in the context of clinical trials when access to medication is guaranteed ( Elwadhi and Cohen, 2020 ). From the patient perspective, evidence from high-income settings suggests that many prefer psychological treatments over medications ( Dorow et al , 2018 ), and recent arguments about the nature of the treatment gap suggest that social interventions may be more in line with the voiced needs of many marginalized groups, alongside, or instead of, medicalized supports ( Roberts et al , 2022 ). Future studies should explore with communities where CM is practiced, what forms of intervention are best suited to their local contexts and communities.…”

Section: Discussionmentioning

confidence: 99%

Bringing an end to the silence: identifying priorities and solutions to addressing the mental health consequences of child marriage

Burgess¹,

Sheibani²,

Kelly³

et al. 2023

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

Despite its inclusion in Sustainable Development Goal 5 (SDG5) to end all harmful gendered practices by 2030, child, early and forced marriage continues to be a pervasive problem globally. While there is consistent evidence on the physical health consequences of child marriage, there is a lack of evidence and inquiry into the mental health consequence. Method: We completed a change-oriented Delphi study to establish consensus on priority areas of research and intervention in relation to the mental health consequences of child, early and forced marriage. Invited experts (n = 11), survivors (n = 27), and professionals (n = 30) participated in our Delphi. Four rounds of data collection included: a blended in-person and online workshops with invited experts, an online mixed-methods questionnaire, focus groups in Zimbabwe with women who are survivors of child marriage and a repeat questionnaire sent to the first round of experts . Quantitative data was analysed using descriptive statistics and ranking methods, consistent with other Delphi studies. Qualitative data was analysed using thematic network analysis. Findings coalesced around three areas: perspectives on the relationship between mental health and child marriage, policy action; and treatment driven solutions. Consensus was reached on 16 items across these areas which included the need to prioritise psychosocial and social interventions to improve mental health outcomes for women and girls in existing marriages. They also called for new approaches to advocacy to drive awareness of this issue in policy circles. Implications for future practice are discussed.

show abstract

Section: Discussionmentioning

confidence: 99%

Bringing an end to the silence: identifying priorities and solutions to addressing the mental health consequences of child marriage

Burgess¹,

Sheibani²,

Kelly³

et al. 2023

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thirdly, talking to a mental health professional was perceived as more helpful by higher SES individuals. As potential explanations, talking therapy might be better tailored to the needs of those higher education 27 and might more readily provide perceivable progress for individuals without poverty related pressures 13 . In conclusion, these findings point to a global 'triple inequality effect', whereby disadvantages of lower SES individuals deepen along each of the three health outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Two systematic reviews using studies from the US and Europe showed that the effectiveness of psychological therapies 11 and antidepressant treatments 12 is lower for low SES individuals. As an explanation, lower SES individuals might face more socio-economic stressors which cannot be relieved by treatment 13 .…”

Section: Socio-economic Factorsmentioning

confidence: 99%

Global inequalities in common mental disorders: Understanding the predictors of lifetime prevalence, treatment utilisation and perceived helpfulness across 111 countries

Henking¹,

Reeves²,

Chrisinger³

2023

Preprint

View full text Add to dashboard Cite

BackgroundSocio-economic inequalities in common mental disorders (CMDs) such as lifetime prevalence, treatment utilisation, and perceived treatment helpfulness have been documented in various settings. However, whether these inequalities are present globally (in both HICs and LMICs) and what factors explain between-country variation is unclear because of inadequate cross-national data. We therefore examine this question using a recently published global, individual-level survey data.MethodsThis study uses a nationally representative individual-level survey dataset (Wellcome Global Monitor 2020), in 111 countries (N= 117,088) to test if socio-economic factors (household income quintile, education), psycho-social factors (local stigma perception, trust in health professionals) and country-level factors (GDP, Gini, health expenditure) predict (1) CMD lifetime prevalence, (2) utilisation and (3) perceived helpfulness of talking to a mental health professional and taking prescribed medication. Multi-level logistic regression models were used.FindingsAcross both HICs and LMICs, individuals in higher household quintiles are less likely to experience anxiety or depression (OR=0.90 for each increase in income quintile, 95% CI[0.89–0.91]), more likely to talk to a mental health professional (OR=1.05[1.03–1.07]) and more likely to perceive this treatment as ‘very helpful’ (OR=1.06[1.03–1.09]). Income is not, however, linked to utilisation (OR=0.98[0.97–1.01]) and helpfulness of taking prescribed medication (OR=1.02[0.99–1.05]). Perceived stigma reduces mental health professional utilisation (OR=0.93[0.90–0.97]) and helpfulness (OR=0.76[0.72–0.81]), while trust in health practitioners increases both utilisation (OR=1.10[1.06–1.14]) and helpfulness (OR=1.32[1.24–1.40]). Country-level health expenditure is related to higher mental health professional utilisation (OR=1.11[1.04–1.19].InterpretationThis analysis reveals a global ‘triple inequality effect’, whereby the disadvantages of lower SES individuals persist in each outcome (lifetime prevalence, treatment utilisation and helpfulness). But these inequalities are moderated by background factors such as stigma and trust in health professionals, and depend on the type of treatment. These findings suggest that addressing inequalities in CMDs cannot focus on only one of these inequalities alone nor can efforts ignore the social context in which they are embedded.

show abstract

“…On the other hand, it may also be the case that communitybased care does not go far enough in addressing the social de terminants of mental health. While many communitybased care models focus on individuals with a mental disorder and their immediate family, very few address the fundamental structural drivers of men tal illness in populations, such as inequal ity, poverty, food insecurity, violence, and hazardous living conditions 111,112 . Suc cessful communitybased mental health services arguably require the existence of viable communities.…”

Section: Deinstitutionalization and Community Mental Health Carementioning

confidence: 99%

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

et al. 2022

View full text Add to dashboard Cite

Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.

show abstract

Reconceptualising the treatment gap for common mental disorders: a fork in the road for global mental health?

Cited by 23 publications

References 24 publications

Bringing an end to the silence: identifying priorities and solutions to addressing the mental health consequences of child marriage

Bringing an end to the silence: identifying priorities and solutions to addressing the mental health consequences of child marriage

Global inequalities in common mental disorders: Understanding the predictors of lifetime prevalence, treatment utilisation and perceived helpfulness across 111 countries

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

Contact Info

Product

Resources

About