A new study has found that around the world, mental illnesses are under-treated compared to their physical disorder counterparts, even though respondents more often attributed their disability to a mental disorder.
The findings were similar regardless of whether the country was considered a high-income (Belgium, France, The Netherlands, Germany, Italy, Spain, Japan, the USA and New Zealand) or middle- or low-income (Colombia, Lebanon, People’s Republic of China, South Africa, Ukraine) country.
The goals of the World Health Organization’s (WHO) 15-country, 73,441-person study were to establish the degree and type of disability, and level of treatment, of specific mental and physical disorders. The WHO’s World Mental Health Surveys were carried out in six countries classified by the World Bank as low- and middle-income and nine as high-income.
The researchers measured treatment sought and received for both physical and mental disorders, and assessed the level and type of disability attributed to them by respondents. The four disability areas explored were home management, ability to work, social life and close personal relationships.
In addition to finding that subjects generally attributed more of their disability to a mental disorder rather than a physical disorder, the researchers discovered that the higher level of disability associated with mental disorders was much more pronounced in social and personal relationships than in productive roles, such as work and housework.
The study also found that the proportion of people receiving treatment at the time of interview was much lower for mental than for physical disorders in high-income countries, and even more so in low- and middle-income countries.
These results are consistent with previous comparative burden-of-illness studies in suggesting that musculoskeletal disorders and major depression are the most disabling disorders across the socioeconomic spectrum.
The researchers comment that these new results imply that mental disorders are disabling more because they create psychological barriers rather than physical barriers to functioning. Among these barriers are limitations in cognitive and motivational capacity, regulation of feelings, embarrassment and stigma.
Disability in productive role functioning, such as work and home management, was generally comparable for mental and physical disorders.
The researchers found it disturbing to find that only a minority of people with severe mental disorders receive treatment and that treatment is substantially more common for severe physical disorders, the researchers say.
Combined with the burden of disability that mental disorders produce, the low treatment rates call for more attention to be paid to mental disorders, they believe. Treatment effectiveness trials show that common anxiety and mood disorders can often be successfully treated, although long-term outcomes are more uncertain and further research is needed.
Despite this uncertainty, the findings of this study strongly imply that more attention should be given to the treatment of mental disorders, particularly in middle- and low- income countries.
The study was published in the May issue of the British Journal of Psychiatry.
Kessler R. C. et al. (2008). Disability and treatment of specific mental and physical disorders across the world. British Journal of Psychiatry 192, 5, 368-375.