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.
Similar content being viewed by others
References
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 33:80–88
Bebbington P, Brugha T, Meltzer H et al (2003) Neurotic disorders and the receipt of psychiatric treatment. Int Rev Psychiatry 15(1/2):108–114
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):115–122
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):2581–2590
Department of Health (1997) White paper for the transformation of the health system in South Africa. Government Gazette, Pretoria
Emsley R (2001) Focus on psychiatry in South Africa. Br J Psychiatry 178:382–386
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: 766–771
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
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):44–49
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)
Health Systems Trust (2005) Health statistics. District health information system database, data extracted May 2005. http://www.hst.org.za/healthstats/
Health Systems Trust. Health statistics. PERSAL personnel administration system. Extracted 2003-19-30. http://www.hst.org.za/healthstats/
Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn, Wiley, New York
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):715–719
Kale R (1995) New South Africa’s mental health. BMJ 10(6989):1254–1256
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 53:1022–1031
Kessler RC, Brown RL, Broman CL (1981) Sex differences in psychiatric help-seeking: evidence from our large-scale surveys. J Health Soc Behav 22:49–64
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):93–121
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):18–24
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):567–578
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 23:1322–1337
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 27:93–105
Lund C, Flisher AJ (2001) South African mental health process indicators. J Ment Health Policy Econ 4(1):9–16
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):157–161
Lund C, Flisher AJ (2002) Staff/population ratios in South African public sector mental health services. S Afr Med J 92(2):161–164
Lund C, Flisher AJ (2003) Community/hospital indicators in South African public sector mental health services. J Ment Health Policy Econ 6:181–187
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):346–349
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 35:1–11
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 50:85–94
Republic of South Africa. Mental health care act (act 17 of 2002). http://www.polity.org.za/pdf/MenralHaelthCareAct17.pdf
Research Triangle Institute (2002) SUDAAN release 8.0.1, Research Triangle Park, Research Triangle Institute, North Carolina
Saxena S, Maulik PK (2003) Mental health services in low- and middle- income countries: an overview. Curr Opin Psychiatry 16: 437–442
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):483–487
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): 257–267
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 29:309–322
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):1579:1582–1585
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):112–117
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
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):841–850
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):629–640
Wells KB, Manning WG, Duan N, Newhouse JP, Ware JE Jr (1986) Sociodemographic factors and the use of outpatient mental health services. Med Care 24:75–85
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):135–147
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):211–220
World Health Organization (1992) Manual of the international statistical classification of diseases, injuries and causes of death: ninth revision, Geneva, Switzerland
Acknowledgments
The South Africa Stress and Health study was funded by grant R01-MH059575 from the National Institute of Mental Health and the National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. Drs. Stein and Seedat are also supported by the Medical Research Council (MRC) of South Africa.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seedat, S., Stein, D.J., Herman, A. et al. Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative). Soc Psychiat Epidemiol 43, 889–897 (2008). https://doi.org/10.1007/s00127-008-0399-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-008-0399-9