-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES:: Perceived discrimination is a prevalent problem that has been linked to negative health outcomes for victims. The goal of this research was to examine whether perceived discrimination within the past 6 months was related to 6-month prevalence of problem drinking, illicit drug use, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) in a sample of primary care patients in Chile. METHODS:: Structured diagnostic assessments were administered to assess for MDD and PTSD using the Composite International Diagnostic Interview. The Alcohol Use Disorders Identification Test assessed hazardous alcohol use. Additional measures captured illegal drug use and discrimination in the past 6 months. Measures were administered to 2839 participants between the ages of 15 to 98 in primary care centers in the Chilean cities of Concepcion and Talcahuano. RESULTS:: Controlling for demographic variables and previous trauma victimization, patients who reported discrimination in the past 6 months were significantly more likely to engage in hazardous alcohol use, illegal drug use, be diagnosed with MDD, and PTSD within this same time period than patients not reporting discrimination. CONCLUSIONS:: This study highlights the importance of considering discrimination as a potential contributing factor to substance use and mental health problems in a Latin American sample.
Journal of Addiction Medicine 09/2012; · 1.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: ADHD prevalence, associated factors, comorbidity and service use are reported for a sample of 1,558 children and adolescents, belonging to four provinces in Chile. The sample is weighted in each step for selection bias. Psychiatric disorders and impairment are assessed with computerized in-home DISC-IV interviews, and a questionnaire regarding socioeconomic and family variables and service use. Estimates of prevalence rates are obtained by means of STATA 11.0 software, with complex sample design. Multivariate logistic regression is used to determine which factors were the best predictors for mental disorders. Participation rate is 82.4 %. The prevalence of ADHD is 10 %, and the most prevalent subtype is the hyperactive/impulsive, with no gender differences. Both hyperactive/impulsive and combined subtypes are more prevalent in children 4-11 than in adolescents. The most prevalent comorbidities are anxiety disorders and oppositional disorder. Anxiety is the more prevalent comorbid disorder in girls and correlated with a combined subtype. Perception of good family functioning, adolescent age and school dropout have a negative association with ADHD diagnosis, while maltreatment shows a positive correlation. Over 50 % of children and adolescents diagnosed with ADHD have used services in the last year. This is the first comprehensive community study of psychiatric disorders in children and adolescents in a South American country. It yields information for child and adolescent mental health programmes in Chile and contributes to cross-cultural epidemiological research.
ADHD Attention Deficit and Hyperactivity Disorders 08/2012;
-
Barbara J Jefferis,
Irwin Nazareth,
Louise Marston,
Berta Moreno-Kustner,
Juan Ángel Bellón,
Igor Svab,
Danica Rotar,
Mirjam I Geerlings,
Miguel Xavier,
Manuel Goncalves-Pereira, Benjamin Vicente,
Sandra Saldivia,
Anu Aluoja,
Ruth Kalda,
Michael King
[show abstract]
[hide abstract]
ABSTRACT: Unemployment is known to be associated with poor mental health, but it is not clear how strongly unemployment leads to onset of diagnosed clinical depression (causation), or if depression raises the risks of becoming unemployed (health selection), or indeed if both pathways operate. We therefore investigate the direction of associations between clinical depression and unemployment in a cross-cultural prospective cohort study. 10,059 consecutive general practice attendees (18-75 years) were recruited from six European countries and Chile between 2003 and 2004 and followed up at six, 12 and (in a subset) 24 months. The analysis sample was restricted to 3969 men and women who were employed or unemployed and seeking employment and had data on depression measures. The outcomes were depressive episodes, assessed using the Depression Section of the Composite International Diagnostic Interview (CIDI) and self-reported employment status. Among 3969 men and women with complete data on depression and unemployment, 10% (n = 393) had depression symptoms and a further 6% (n = 221) had major depression at 12 months. 11% (n = 423) of the sample were unemployed by 6 months. Participants who became unemployed between baseline and 6 months compared to those employed at both times had an adjusted relative risk ratio for 12-month depression of 1.58 (95% Confidence Interval 0.76, 3.27). Participants with depression at baseline and 6 months compared to neither time had an odds ratio for 6-month unemployment of 1.58 (95% Confidence Interval 0.97, 2.58). We found evidence that causation and (to a lesser extent) health selection raise the prevalence of depression in the unemployed. Unemployed adults are at particular risk for onset of major clinical depression and should be offered extra services or screened. Given the trend for adults with depression to perhaps be at greater risk of subsequent unemployment, employees with depressive symptoms should also be supported at work as a precautionary principle.
Social Science [?] Medicine 12/2011; 73(11):1627-34. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in Santiago, Chile, as part of a national sample.
Subjects aged 4-18 were selected using a stratified multistage design. First, ten municipalities/comunas of Santiago were selected; then the blocks, homes, and child or adolescent to be interviewed were chosen. Psychology graduate students administered the Spanish-language, computer-assisted version of DISC-IV that estimated DSM-IV 12-month prevalence.
A total of 792 children and adolescents were evaluated, with a participation rate of 76.7%. The most stringent impairment DSM-IV DISC algorithm for psychiatric disorders revealed a prevalence of 25.4% (20.7% for boys and 30.3% for girls). The majority of the diagnoses corresponded to anxiety and affective disorders. Prevalence was higher in children aged 4-11 (31.9%) than in adolescents aged 12-18 (18.2%). This difference was mainly accounted for by disruptive disorders in the younger age group. Anxiety disorders had the highest prevalence, although impairment was low. In contrast, most children and adolescents with affective disorders were impaired.
In Santiago, the prevalence of psychiatric disorders in children and adolescents was high. This study helps raise awareness of child and adolescent mental health issues in Spanish-speaking Latin America and serves as a basis for improving mental health services.
Social Psychiatry 07/2011; 47(7):1099-109. · 2.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Little attention has been given to the prevalence rate of mental illness among elderly adults in Latin America. The prevalence rates for psychiatric disorders in Chile among those 65 and older compared with younger individuals, and the prevalence rate of psychiatric disorders among those age 75 and older are presented.
A stratified random sample of 2,659 individuals.
Four provinces representative of the Chile's population were surveyed.
Adults age 15 and older were interviewed; however, the analysis is limited to those over age 20.
The Composite International Diagnostic Interview was administered to obtain Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R diagnoses. Lifetime and 12-month prevalence rates were estimated.
Of the 2,659 interviewed 352 were over age 64. Overall, elderly adults had lower prevalence rates of lifetime disorders than the younger population, 20% in comparison with 34%. Dysthymia, agoraphobia, simple phobia, and alcohol dependence disorders were noted to be less common among elderly subjects. Those over the age of 64 in comparison with those over the age of 74 had higher prevalence rates of disorders. A sizable proportion of the disorders among older adults began after the age of 59. One third of elderly respondents with major depression had a late onset disorder. Service utilization was similar between elderly individuals and younger respondents, except for use of specialized psychiatric services, which was lower among elderly adults.
Both lifetime and 1-year prevalence of mental disorders were less common in older than in younger persons; however, among elderly adults late onset disorders were not uncommon. Additional studies of the prevalence rates of disorders among older individuals in Latin America are needed for public health planning.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 01/2009; 16(12):1020-8. · 3.35 Impact Factor
-
Michael King,
Carl Walker,
Gus Levy,
Christian Bottomley,
Patrick Royston,
Scott Weich,
Juan Angel Bellón-Saameño,
Berta Moreno,
Igor Svab,
Danica Rotar, [......],
Jan Neeleman,
Mirjam I Geerlings,
Miguel Xavier,
Idalmiro Carraça,
Manuel Gonçalves-Pereira, Benjamin Vicente,
Sandra Saldivia,
Roberto Melipillan,
Francisco Torres-Gonzalez,
Irwin Nazareth
[show abstract]
[hide abstract]
ABSTRACT: Strategies for prevention of depression are hindered by lack of evidence about the combined predictive effect of known risk factors.
To develop a risk algorithm for onset of major depression.
Cohort of adult general practice attendees followed up at 6 and 12 months. We measured 39 known risk factors to construct a risk model for onset of major depression using stepwise logistic regression. We corrected the model for overfitting and tested it in an external population.
General practices in 6 European countries and in Chile.
In Europe and Chile, 10 045 attendees were recruited April 2003 to February 2005. The algorithm was developed in 5216 European attendees who were not depressed at recruitment and had follow-up data on depression status. It was tested in 1732 patients in Chile who were not depressed at recruitment. Main Outcome Measure DSM-IV major depression.
Sixty-six percent of people approached participated, of whom 89.5% participated again at 6 months and 85.9%, at 12 months. Nine of the 10 factors in the risk algorithm were age, sex, educational level achieved, results of lifetime screen for depression, family history of psychological difficulties, physical health and mental health subscale scores on the Short Form 12, unsupported difficulties in paid or unpaid work, and experiences of discrimination. Country was the tenth factor. The algorithm's average C index across countries was 0.790 (95% confidence interval [CI], 0.767-0.813). Effect size for difference in predicted log odds of depression between European attendees who became depressed and those who did not was 1.28 (95% CI, 1.17-1.40). Application of the algorithm in Chilean attendees resulted in a C index of 0.710 (95% CI, 0.670-0.749).
This first risk algorithm for onset of major depression functions as well as similar risk algorithms for cardiovascular events and may be useful in prevention of depression.
Archives of general psychiatry 01/2009; 65(12):1368-76. · 12.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is a demand for international comparisons of mental health care in Latin America. The purpose of this study was to describe mental health care in catchment health areas in Chile and Spain in order to complement information reported at the macro-level (countries or regions).
Availability and utilization of services for the adult population were assessed in two urban areas in Chile and in three urban areas in Spain by using the European Service Mapping Schedule (meso-level data). Indicators from a previous data envelopment analysis (DEA) model of basic community care were applied to this analysis.
For the two countries, local data on beds and staff differed from data provided at the national level. In Chile meso-level data indicated more available beds and more psychologists per capita than did macro-level data. Quantitative indicators of community care were described, and the main gaps in Chile's urban areas were identified, particularly in day care and nonhospital residential care. There was nearly a tenfold difference in use of residential and day care between the benchmark area in Spain and the areas explored in Chile. In Chile's catchment areas there was no availability of nonacute hospital services, any work-related services for persons with mental disorders, or 24-hour mobile or nonmobile emergency psychiatric care. The meso-level data indicated that delivery and use of care in Chile was more similar to the pattern found in the poorer area in southern Spain than macro-level data would indicate.
The European Service Mapping Schedule was useful for describing mental health care outside of Europe and allowed for an international comparison between Chile and Spain. The meso-level description gathered in this study adds to the macro-level information on the mental health care system that has been provided in other reports. The gap between mental health treatment needed and mental health treatment received in Chile may be lower than expected.
Psychiatric Services 05/2008; 59(4):421-8. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study evaluated the results of a brief 2-day educational training program for Chilean primary care physicians that measured changes in knowledge, attitudes and practice. This World Psychiatric Association (WPA) program was adopted to overcome diagnostic and treatment problems that are found among primary care practitioners.
37 primary care physicians from two cities in Chile and 2589 patients participated. Physician's knowledge, attitudes and clinical practice were assessed 1 month prior and 1 month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times.
The results suggested that, with this group of Chilean doctors, the WPA program was effective in improving knowledge about depression and in changing some disorder-related attitudes. In addition, it had some limited impact on actual clinical practice, although the rate of diagnosis remained stable and the post-training agreement between physician diagnosis and patient self-report remained low. The physicians seemed more confident in treating patients and demonstrated increased use of antidepressant agents.
The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression, but their competence to play a crucial role remains limited. Further training of primary care physicians to improve the management of major depression continues to be needed.
Journal of Affective Disorders 03/2007; 98(1-2):121-7. · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Psychiatric epidemiological surveys in developing countries are rare and are frequently conducted in regions that are not necessarily representative of the entire country. In addition, in large countries with dispersed populations national rates may have low value for estimating the need for mental health services and programs.
The Chile Psychiatric Prevalence Study using the Composite International Diagnostic Interview was conducted in four distinct regions of the country on a stratified random sample of 2,978 people. Lifetime and 12-month prevalence and service utilization rates were estimated.
Significant differences in the rates of major depressive disorder, substance abuse disorders, non-affective psychosis, and service utilization were found across the regions. The differential prevalence rates could not be accounted by socio-demographic differences between sites.
Regional differences across countries may exist that have both implications for prevalence rates and service utilization. Planning mental health services for population centers that span wide geographical areas based on studies conducted in a single region may be misleading, and may result in areas with high need being underserved.
Social Psychiatry 01/2007; 41(12):935-42. · 2.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans.
The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile.
The lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among persons exposed to trauma, rape was most strongly associated with PTSD. Onset of PTSD significantly increased the risk of developing each of the 10 other tested disorders. Among those exposed to trauma, women were significantly more likely to develop PTSD, after controlling for assaultive violence.
This study highlights the importance of investigating the prevalence of PTSD, patterns of co-morbidity of PTSD, and gender differences in PTSD in non-English-speaking countries.
Psychological Medicine 12/2006; 36(11):1523-33. · 6.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although several epidemiological studies of the prevalence of psychiatric disorders have been conducted in Latin America, few of them were national studies that could be used to develop region-wide estimates. Data are presented on the prevalence of DSM-III-R disorders, demographic correlates, comorbidity, and service utilization in a nationally representative adult sample from Chile.
The Composite International Diagnostic Interview was administered to a stratified random sample of 2,978 individuals from four provinces representative of the country's population age 15 and older. Lifetime and 12-month prevalence rates were estimated.
Approximately one-third (31.5%) of the population had a lifetime psychiatric disorder, and 22.2% had a disorder in the past 12 months. The most common lifetime psychiatric disorders were agoraphobia (11.1%), social phobia (10.2%), simple phobia (9.8%), major depressive disorder (9.2%), and alcohol dependence (6.4%). Of those with a 12-month prevalence diagnosis, 30.1% had a comorbid psychiatric disorder. The majority of those with comorbidity had sought out mental health services, in contrast to one-quarter of those with a single disorder.
The prevalence rates in Chile are similar to those obtained in other studies conducted in Latin America and Spanish-speaking North American groups. Comorbidity and alcohol use disorders, however, were not as prevalent as in North America.
American Journal of Psychiatry 09/2006; 163(8):1362-70. · 12.54 Impact Factor
-
Michael King,
Scott Weich,
Francisco Torres-González,
Igor Svab,
Heidi-Ingrid Maaroos,
Jan Neeleman,
Miguel Xavier,
Richard Morris,
Carl Walker,
Juan A Bellón-Saameño, [......],
Janez Rifel,
Anu Aluoja,
Ruth Kalda,
Mirjam I Geerlings,
Idalmiro Carraça,
Manuel Caldas de Almeida, Benjamin Vicente,
Sandra Saldivia,
Pedro Rioseco,
Irwin Nazareth
[show abstract]
[hide abstract]
ABSTRACT: Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation.
This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent.
Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.
BMC Public Health 02/2006; 6:6. · 2.00 Impact Factor
-
Michael King,
Scott Weich,
Francisco Torres-González,
Igor Švab,
Heidi-Ingrid Maaroos,
Jan Neeleman,
Miguel Xavier,
Richard Morris,
Carl Walker,
Juan Bellón-Saameño, [......],
Janez Rifel,
Anu Aluoja,
Ruth Kalda,
Mirjam Geerlings,
Idalmiro Carraça,
de Almeida Manuel, Benjamin Vicente,
Sandra Saldivia,
Pedro Rioseco,
Irwin Nazareth
[show abstract]
[hide abstract]
ABSTRACT: Abstract
Background
Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation.
Methods/design
This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent.
Discussion
Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.
BMC Public Health. 01/2006;
-
[show abstract]
[hide abstract]
ABSTRACT: The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America.
The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence.
The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated.
Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low.
This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.
International Journal of Social Psychiatry 07/2005; 51(2):119-27. · 1.15 Impact Factor
-
Itzhak Levav,
Robert Kohn,
Ivan Montoya,
Carlos Palacio,
Pablo Rozic,
Ida Solano,
Willians Valentini, Benjamin Vicente,
Jorge Castro Morales,
Francisco Espejo Eigueta,
Yamini Saravanan,
Claudio T Miranda,
Norman Sartorius
[show abstract]
[hide abstract]
ABSTRACT: In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP).
One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist.
The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists.
Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.
Psychological Medicine 02/2005; 35(1):35-45. · 6.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Few South American studies have examined current prevalence rates of psychiatric disorders.
To examine prevalence rates in a nationally representative adult population from Chile.
The Composite International Diagnostic Interview was administered to a stratified random sample of 2978 individuals from four provinces representative of the country's population. Six-month and 1-month prevalence rates were estimated. Demographic correlates, comorbidity and service use were examined.
Nearly a fifth of the Chilean population had had a psychiatric disorder during the preceding 6 months. The 6-month and 1-month prevalence rates were 19.7% and 16.7% respectively. For the 6-month prevalence the five most common disorders were simple phobia, social phobia, agoraphobia, major depressive disorder and alcohol dependence. Less than 30% of those with any psychiatric diagnosis had a comorbid psychiatric disorder and the majority of them had sought treatment from mental health services.
Current prevalence studies are useful indicators of service needs. People with comorbid psychiatric conditions have high rates of service use. The low rate of comorbidity in Chile merits further study.
The British Journal of Psychiatry 05/2004; 184:299-305. · 6.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: S: To address the growing burden of mental illness in Latin America, a better understanding of mental health service use and barriers to care is needed. Although many Latin American countries have nationalized health care systems that could potentially improve access to care, significant barriers to care remain. The authors report the results of a study examining mental health service utilization in the general population of Chile.
The data were drawn from the Chile Psychiatric Prevalence Study, a national household survey of 2,987 persons aged 15 years and older conducted in 1992-1999. As part of the survey, psychiatric diagnoses were obtained by using the Composite International Diagnostic Interview, and respondents were asked about their use of general and mental health care services in the past six months and about their experience of barriers to treatment.
More than 44 percent of respondents reported use of any health care services in the past six months, and 20 percent reported use of mental health services. Of the respondents who met criteria for a psychiatric disorder, a large proportion (62 percent) did not receive mental health care. Increasing severity of the psychiatric disorder correlated with increasing frequency of overall help seeking, but only a small proportion of the respondents with a psychiatric disorder sought specialized mental health services. Regional disparities and inequities in access to care were found. In addition, indirect barriers to mental health care, such as stigma and misconceptions about the course of psychiatric disorders, were important deterrents to service utilization, particularly among persons with lower socioeconomic status.
To reduce the burden of mental illness in Chile, additional efforts are needed to address both the direct and the indirect barriers to mental health care, including regional inequities in access to care.
Psychiatric Services 02/2004; 55(1):71-6. · 2.38 Impact Factor
-
Rob V Bijl,
Ron de Graaf,
Eva Hiripi,
Ronald C Kessler,
Robert Kohn,
David R Offord,
T Bedirhan Ustun, Benjamin Vicente,
Wilma A M Vollebergh,
Ellen E Walters,
Hans-Ulrich Wittchen
[show abstract]
[hide abstract]
ABSTRACT: We analyzed survey data from Canada, Chile, Germany, The Netherlands, and the United States to study the prevalence and treatment of mental and substance abuse disorders. Total past-year prevalence estimates range between 17.0 percent (Chile) and 29.1 percent (U.S.). Many cases are mild. Although disorder severity is strongly related to treatment, one- to two-thirds of serious cases receive no treatment each year. Most treatment goes to minor and mild cases. Undertreatment of serious cases is most pronounced among young poorly educated males. Outreach is needed to reduce barriers to care among serious cases and young people at risk of serious disorders.
Health Affairs 22(3):122-33. · 4.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study compared the prevalence rates of various psychiatric disorders in persons with first onset of a potentially traumatic event (PTE) in childhood, persons with first onset of a PTE in adulthood, and those with no history of a PTE in a representative sample of Chileans. The Diagnostic of Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), posttraumatic stress disorder, and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview were administered to 2390 Chileans. The study found that exposure to a lifetime PTE was associated with a higher probability of psychiatric morbidity than no PTE exposure. A PTE with childhood onset relative to adult onset was related to lifetime panic disorder, independent of the number of lifetime and demographic differences between the 2 groups. Childhood interpersonal trauma compared with interpersonal trauma in adulthood was significantly associated with lifetime panic disorder, agoraphobia, and posttraumatic stress disorder. Our findings suggest that specific disorders are linked to interpersonal trauma and PTEs that occur in childhood rather than later in life.
Comprehensive Psychiatry 49(2):163-9. · 2.26 Impact Factor
