ArticlePsychological medicine2021
Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative.
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Article in Psychological medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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29 citing papers in PubMed, 52 citations in OpenAlex.
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- Retention and effectiveness of group interpersonal psychotherapy (IPT-G) to treat depression at scale in Uganda and Zambia.BMJ global health · 2025Article
- Mental Health Treatment among U.S. Military Veterans: Insights from the National Health Interview Survey.Journal of general internal medicine · 2025Article
- Observational
- Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.JMIR mental health · 2025Article
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Authors and funding
32 authors at 20 institutions in 22 countries.
Daniel FernándezParc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.ORCID 0000-0003-0012-2094
Daniel VigoDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Nancy A SampsonDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Irving HwangDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Sergio Aguilar-GaxiolaCenter for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
Ali O Al-HamzawiCollege of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq.
Jordi AlonsoHealth Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
Laura Helena AndradeNúcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Evelyn J BrometDepartment of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA.
Giovanni de GirolamoIRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Peter de JongeDepartment of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands.
Silvia FlorescuNational School of Public Health, Management and Development, Bucharest, Romania.
Oye GurejeDepartment of Psychiatry, University College Hospital, Ibadan, Nigeria.
Hristo HinkovNational Center of Public Health and Analyses, Sofia, Bulgaria.
Chiyi HuShenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China.
Elie G KaramDepartment of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon.
Georges KaramDepartment of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon.
Norito KawakamiDepartment of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan.
Andrzej KiejnaWroclaw Medical University; University of Lower Silesia, Wroclaw, Poland.
Viviane Kovess-MasfetyEcole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France.
Maria E Medina-MoraNational Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
Fernando Navarro-MateuUDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain.
Akin OjagbemiDepartment of Psychiatry, University College Hospital, Ibadan, Nigeria.
Siobhan O'NeillSchool of Psychology, Ulster University, Londonderry, United Kingdom.
Marina PiazzaUniversidad Cayetano Heredia, Lima, Peru.
Jose Posada-VillaFaculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
Charlene RapseyDepartment of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
David R WilliamsDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Miguel XavierNOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal and.
Yuval ZivMental Health Services, Israeli Ministry of Health, Jerusalem, Israel.
Ronald C KesslerDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Josep M HaroParc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.
Harvard University · USCentro de Investigación Biomédica en Red · ESUniversity College Hospital, Ibadan · NGUniversity of Balamand · LBCentro San Giovanni di Dio Fatebenefratelli · ITÉcole des Hautes Études en Santé Publique · FRHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo · BRInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz · MXIsrael Ministry of Health · ILNational Center of Public Health and Analyses · BGNational School of Public Health, Management and Professional Development · ROServicio Murciano de Salud · ESShenzhen KangNing Hospital · CNStony Brook University · USThe University of Tokyo · JPUC Davis Health · USUniversidad Colegio Mayor de Cundinamarca · COUniversidade Nova de Lisboa · PTUniversidad Peruana Cayetano Heredia · PEUniversitat Pompeu Fabra · ES
Funding
EPIDEMIOLOGY-- NATIONAL COMORBIDITY SURVEY REPLICATIONU01MH060220 · NIMH · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI KESSLER, RONALD C · 1999 to 2010
$18.7MRisk Factors for Psychopathology in the WHO WMH SurveysR01MH070884 · NIMH · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI KESSLER, RONALD C · 2005 to 2009
$6.0MTrauma, Stress, and Mental Health in South AfricaR01MH059575 · NIMH · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI WILLIAMS, DAVID R · 1998 to 2007
$2.5MSocial Role Disability and Mental-Physical Co-MorbidityR01MH069864 · NIMH · KAISER FOUNDATION HEALTH PLAN OF WASHINGTON · PI VON KORFF, MICHAEL R · 2004 to 2007
$2.2MCOMORBID MENTAL DISORDERS IN PERIODS OF SOCIAL DISRUPTIOR01MH061905 · NIMH · STATE UNIVERSITY NEW YORK STONY BROOK · PI BROMET, EVELYN J · 2000 to 2004
$1.7MCROSS-NATIONAL STUDIES OF DRUG INVOLVEMENT: WMH2000R01DA016558 · NIDA · MICHIGAN STATE UNIVERSITY · PI ANTHONY, JAMES CHRISTOPHER · 2003 to 2008
$1.7MWorld Mental Health Consortium Annual Meeting 2003-07R13MH066849 · NIMH · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HEERINGA, STEVEN G · 2003 to 2007
$735kLebanon-Epidemiology: The NCS Replication StudyR03TW006481 · FIC · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI KESSLER, RONALD C · 2004 to 2006
$142kFIC NIH HHS R03 TW006481NIDA NIH HHS R01 DA016558NIMH NIH HHS R01 MH059575NIMH NIH HHS R01 MH061905NIMH NIH HHS R01 MH069864NIMH NIH HHS R01 MH070884NIMH NIH HHS R13 MH066849NIMH NIH HHS U01 MH060220
Abstract
backgroundThere is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
methodsRespondents from 13 low- or middle-income countries (
resultsDropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60%
conclusionsExtending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Indexed as
Mental DisordersMental Health ServicesDeveloped CountriesHealth SurveysHumansOutpatientsSurveys and QuestionnairesWorld Health OrganizationDropoutmental healthsurvival analysisWMH surveys
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