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Treatment Gap of Mental Disorders in São Paulo Metropolitan Area, Brazil: Failure and Delay in Initiating Treatment Contact After First Onset of Mental and Substance Use Disorders

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Abstract

An under-studied crucial step in the health-related help-seeking process is making prompt contact with a treatment provider when a mental disorder strikes. This study aims to provide data on patterns and predictors of failure and delay in making initial treatment contact after the first onset of a mental disorder among adult residents in São Paulo, Brazil. A representative face-to-face household survey was conducted among 5,037 respondents aged 18 + years to assess lifetime psychiatric diagnosis, treatment contact, and delay using the World Mental Health Composite International Diagnostic Interview. Cumulative lifetime probability curves show that most people with lifetime disorders eventually make treatment contact, and this is more frequent among those with mood (94.4%) than anxiety (63.6%) and substance use disorders (46.4%). Median delay of treatment contact ranged from 3 to 13 years for mood, 1 to 36 years for anxiety, and 8 to 14 for substance use disorders. Earlier onset was associated with lower probabilities of treatment contact for most disorders (10 out of 15). Failure to promptly seek/receive treatment is a pervasive aspect of the unmet need for mental health care in Brazil.

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Data Availability

Public access to the diagnostic instrument, including diagnostic algorithms, should be requested via: http:// www.hcp.med.harvard.edu/wmh. Nevertheless, there are limitations on the availability of raw data due to ethical restrictions related to sensitive information and to the signed agreement with the WHO World Mental Health Survey Initiative to limit comparative analyses to those carried out within the consortium. Requestors wishing to access a de-identified minimal dataset necessary for only monitoring purposes of our published analyses can apply to Dr Maria Carmen Viana: mcviana6@gmail.com.

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Acknowledgements

The São Paulo Megacity Mental Health Survey was carried out with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff members from the Post Graduate Program in Public Health—Federal University of Espírito Santo, Brazil, and the WMH staff for assistance with instrumentation, fieldwork, and data analysis. We also thank the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Fundo de Apoio a Ciência e Tecnologia do Municipio de Vitória (FACITEC) for the financial support. The authors declare that the funders of the Sao Paulo Megacity Mental Health Survey had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The São Paulo Megacity Mental Health (SPMH) Survey was funded by the São Paulo Research Foundation, Brazil (FAPESP Grant numbers# 2003/00204-3 and 2011/50517-4). Instrument development was supported by the Fundo de Apoio à Ciência e Tecnologia do Município de Vitória (FACITEC -Vitoria Foundation for Science and Technology Grant number# 002/2003). The São Paulo Megacity Mental Health Survey is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. The main coordination center activities, at Harvard University, were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. Development supports Dr Maria Carmen (Fundação de Amparo à Pesquisa do Estado de São Paulo—FAPESP Grant# 08/53818-2 and CNPq Grant# 314218/2018-1). The authors declare that the funders of the SPMH Survey had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors also declare that the commercial funders of the Harvard coordination centre had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Funding

The São Paulo Megacity Mental Health Survey was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Thematic Project Grant 03/00204–3. Instrument development was supported by the Fundo de Apoio à Ciência e Tecnologia do Município de Vitória (FACITEC -Vitoria Foundation for Science and Technology 002/2003). The São Paulo Megacity Mental Health Survey is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. MCV was funded by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Post-Doctoral Grant 08/53818–2) and is supported by the Brazilian Research Council (CNPq) (Produtividade em Pesquisa 314218/2018–1).

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Authors and Affiliations

  1. Post-Graduate Program in Public Health, Federal University of Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, 29047-105, Brazil

    Mariane Henriques França

  2. Section of Psychiatric Epidemiology – LIM 23, Department and Institute of Psychiatry, University of São Paulo, Medical School, São Paulo, SP, 05403-000, Brazil

    Yuan-Pang Wang & Laura Helena Andrade

  3. Department of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES, 29047-105, Brazil

    Maria Carmen Viana

Authors
  1. Mariane Henriques França
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  2. Yuan-Pang Wang
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  3. Laura Helena Andrade
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  4. Maria Carmen Viana
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Contributions

All authors contributed to the study conception and design. Mariane Henriques Franca conceived and designed the experiments, performed the experiments, analyzed the data, and wrote the paper. Laura Helena Andrade conceived and designed the experiments and wrote the paper. Yuan-Pang Wang wrote and revised the paper. Maria Carmen Viana conceived and designed the experiments, performed the experiments, analyzed the data, and wrote the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mariane Henriques França.

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Ethics Approval

This study was approved by the Research and Ethics Committee of the University of São Paulo Medical School through the research protocol number 792/03 titled: “Mental and behavioral disorders in the general population: Prevalence, Risk Factors, and Social and Economic Burden” presented by the Department of Psychiatry, including the Informed Consent Form.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 and its later amendments. Informed consent was obtained from all patients for being included in the study.

Conflict of Interest

The authors declare no competing interests.

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França, M.H., Wang, YP., Andrade, L.H. et al. Treatment Gap of Mental Disorders in São Paulo Metropolitan Area, Brazil: Failure and Delay in Initiating Treatment Contact After First Onset of Mental and Substance Use Disorders. Int J Ment Health Addiction 21, 3659–3677 (2023). https://doi.org/10.1007/s11469-022-00814-0

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