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Social Psychiatry and Psychiatric Epidemiology

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01-11-2008 | ORIGINAL PAPER

Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative)

Authors: Soraya Seedat, D. J. Stein, A. Herman, R. Kessler, J. Sonnega, S. Heeringa, S. Williams, D. Williams

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 11/2008

Abstract

Background

The proportion of people with mental disorders in treatment is relatively small in low and middle income countries. However, little is known about patterns of recent service use in a country like South Africa.

Methods

A nationally representative household survey of 4,351 adult South Africans was carried out. Twelve-month DSM-IV disorders were determined using the WHO composite international diagnostic interview (CIDI). Prevalence and correlates of treatment were assessed among respondents with anxiety, mood and substance use disorders.

Results

One-fourth (25.5%) of respondents with a 12-month disorder had received treatment in the past 12 months either from a psychiatrist (3.8%), nonpsychiatrist mental health specialist (2.9%), general medical provider (16.6%), human services provider (6.6%), or complementary-alternative medical (CAM) provider (5.9%). Only 27.6% of severe cases had received any treatment. In addition, 13.4% of respondents with no disorder had accessed services in the past year. Blacks were significantly more likely than other racial groups to access the CAM sector while Whites were more likely to have seen a psychiatrist.

Conclusions

The majority of South Africans with a 12-month mental disorder have unmet treatment needs. In addition to a greater allocation of resources to mental health services, more community outreach and awareness initiatives are needed.

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DC

American Psychiatric Association (1998) Practice guideline for treatment of patients with panic disorder. American Psychiatric Association Press, Washington, DC

American Psychiatric Association (2000) Practice guideline for treatment of patients with major depressive disorder, 2nd edn. American Psychiatric Association Press, Washington, DC

American Psychiatric Association (2002) Practice guideline for treatment of patients with bipolar disorder, 2nd edn, American Psychiatric Association Press, Washington, DC

Andrew G, Peters L (1998) The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol 33:80–88CrossRef

Bebbington P, Brugha T, Meltzer H et al (2003) Neurotic disorders and the receipt of psychiatric treatment. Int Rev Psychiatry 15(1/2):108–114PubMedCrossRef

Bebbington P, Meltzer H, Brugha T, Farrell M, Jenkins R, Ceresa C, Lewis G (2003) Unequal access and unmet need: neurotic disorders and the use of primary care services. Int Rev Psychiatry 15(1/2):115–122PubMedCrossRef

Behr GM, Allwood CW (1995) Differences between western and African models of psychiatric illness. SAMJ 85:580–584

Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC et al (2004) WHO world mental health survey consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys. JAMA 291(21):2581–2590PubMedCrossRef

10.

Department of Health (1997) White paper for the transformation of the health system in South Africa. Government Gazette, Pretoria

11.

Emsley R (2001) Focus on psychiatry in South Africa. Br J Psychiatry 178:382–386PubMedCrossRef

12.

Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33: 766–771PubMed

13.

Freeman M, Lee T, Vivian W (1994) Evaluation of mental health services in the Orange Free State, South Africa. Centre for Health Policy, Department of Community Health, Wits Medical School, Johannesburg, South Africa

14.

Gureje O, Lasebikan VO (2006) Use of mental health services in a developing country results from the Nigerian survey of mental health and well-being. Soc Psychiatry Psychiatr Epidemiol 41(1):44–49PubMedCrossRef

15.

Haro JM, Arbabzadeh-Bouchez SBTS, Girolamo GD, Guyer M, Jin R, et al (2006) Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO world mental health surveys. Int J Methods Psychiatr Res (in press)

16.

Health Systems Trust (2005) Health statistics. District health information system database, data extracted May 2005. http://www.hst.org.za/healthstats/

17.

Health Systems Trust. Health statistics. PERSAL personnel administration system. Extracted 2003-19-30. http://www.hst.org.za/healthstats/

18.

Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn, Wiley, New York

19.

Hugo CJ, Boshoff DE, Traut A, Zungu-Dirwayi N, Stein DJ (2003) Community attitudes toward and knowledge of mental illness in South Africa. Soc Psychiatry Psychiatr Epidemiol 38(12):715–719PubMedCrossRef

20.

Kale R (1995) New South Africa’s mental health. BMJ 10(6989):1254–1256

21.

Kendler KS, Gallagher TJ, Abelson JM, Kessler RC (1996) Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The national comorbidity survey. Arch Gen Psychiatry 53:1022–1031PubMed

22.

Kessler RC, Brown RL, Broman CL (1981) Sex differences in psychiatric help-seeking: evidence from our large-scale surveys. J Health Soc Behav 22:49–64PubMedCrossRef

23.

Kessler RC, Ustun TB (2004) The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121PubMedCrossRef

24.

Kohn R, Szabo CP, Gordon A, Allwood CW (2004) Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists’ perceptions. Int J Soc Psychiatry 50(1):18–24PubMedCrossRef

25.

Lasser KE, Himmelstein DU, Woolhandler SJ, McCormick D, Bor DH (2002) Do minorities in the United States receive fewer mental health services than whites? Int J Health Serv 32(3):567–578PubMedCrossRef

26.

Leaf PJ, Livingston MM, Tischler GL, Weissman MM, Holzer CE, Myers JK (1985) Contact with health professionals for the treatment of psychiatric and emotional problems. Med Care 23:1322–1337PubMedCrossRef

27.

Leon AC, Olfson M, Portera L, Farber L, Sheehan DV (1997) Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med 27:93–105PubMed

28.

Lund C, Flisher AJ (2001) South African mental health process indicators. J Ment Health Policy Econ 4(1):9–16PubMed

29.

Lund C, Flisher AJ (2002) Staff/bed and staff/patient ratios in South African public sector mental health services. S Afr Med J 92(2):157–161PubMed

30.

Lund C, Flisher AJ (2002) Staff/population ratios in South African public sector mental health services. S Afr Med J 92(2):161–164PubMed

31.

Lund C, Flisher AJ (2003) Community/hospital indicators in South African public sector mental health services. J Ment Health Policy Econ 6:181–187PubMed

32.

Lund C, Flisher AJ, Porteus K, Lee T (2002) Bed/population ratios in South African public sector mental health services. Soc Psychiatry Psychiatr Epidemiol 37(7):346–349PubMedCrossRef

33.

Medina-Mora ME, Borges G, Lara C et al (2005) Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican national comorbidity survey. Psychol Med 35:1–11CrossRef

34.

Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK (1993) The de facto U.S. mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 50:85–94PubMed

35.

Republic of South Africa. Mental health care act (act 17 of 2002). http://www.polity.org.za/pdf/MenralHaelthCareAct17.pdf

36.

Research Triangle Institute (2002) SUDAAN release 8.0.1, Research Triangle Park, Research Triangle Institute, North Carolina

37.

Saxena S, Maulik PK (2003) Mental health services in low- and middle- income countries: an overview. Curr Opin Psychiatry 16: 437–442CrossRef

38.

Seedat S, Stein DJ, Berk M, Wilson Z (2002) Barriers to treatment among members of a mental health advocacy group in South Africa. Soc Psychiatry Psychiatr Epidemiol 37(10):483–487PubMedCrossRef

39.

Shen Y-C, Zhang M-Y, Huang Y-Q et al (2006) Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychol Med 36(2): 257–267PubMedCrossRef

40.

Spengler PA, Wittchen HU (1988) Procedural validity of standardized symptom questions for the assessment of psychotic symptoms–a comparison of the DIS with two clinical methods. Compr Psychiatry 29:309–322PubMedCrossRef

41.

Stein DJ, Roberts M, Hollander E, Rowland C, Serebro P (1996) Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey. S Afr Med J 86(Suppl 2):1579:1582–1585PubMed

42.

Stein DJ, Seedat S, Herman A, Moomal H, Heeringa SG, Kessler RC, Williams DR (2008) Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatry 192(2):112–117PubMedCrossRef

43.

U.S. Department of Health and Human Services (1999) Mental health: a report of the surgeon general. U.S. Department of Health and Human Services, Rockville. Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health

44.

Wang PS, Aguilar-Gaxiola S, Alonso J et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850PubMedCrossRef

45.

Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States: results from the national comorbidity survey replication. Arch Gen Psychiatry 62(6):629–640PubMedCrossRef

46.

Wells KB, Manning WG, Duan N, Newhouse JP, Ware JE Jr (1986) Sociodemographic factors and the use of outpatient mental health services. Med Care 24:75–85PubMedCrossRef

47.

Williams DR, Herman A, Kessler RC, Sonnega J, Seedat S, Stein DJ, Moomal H, Wilson CM (2004) The South Africa stress and health study: rationale and design. Metab Brain Dis 19(1/2):135–147PubMedCrossRef

48.

Williams DR, Herman A, Stein DJ, Heeringa SG, Jackson PB, Moomal H, Kessler RC (2008) Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African stress and health study. Psychol Med 38(2):211–220PubMedCrossRef

49.

World Health Organization (1992) Manual of the international statistical classification of diseases, injuries and causes of death: ninth revision, Geneva, Switzerland

Title: Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative)
Authors: Soraya Seedat
D. J. Stein
A. Herman
R. Kessler
J. Sonnega
S. Heeringa
S. Williams
D. Williams
Publication date: 01-11-2008
Publisher: D. Steinkopff-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 11/2008
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-008-0399-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative)

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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