S. Aguilar-gaxiola
University of California, Davis, Internal Medicine, Faculty Member
- Sergio Aguilar-Gaxiola, MD, PhD is Professor of Clinical Internal Medicine, School of Medicine, University of Califor... moreSergio Aguilar-Gaxiola, MD, PhD is Professor of Clinical Internal Medicine, School of Medicine, University of California, Davis. He is the Founding Director of the Center for Reducing Health Disparities at UC Davis Health and the Director of the Community Engagement Program of the Clinical Translational Science Center (CTSC). He is currently a Member of the National Advisory Council of the Substance Abuse and Mental Health Administration (SAMHSA) Center for Mental Health Services since 2019 and a board member of the California Health Care Foundation. He is a national and international expert on health and mental health comorbidities on diverse populations. He has held several World Health Organization (WHO) and Pan American Health Organization (PAHO) advisory board and consulting appointments and is currently a member of the Executive Committee of the World Health Organization (WHO) World Mental Health Survey Consortium (WMH) and its Coordinator for Latin America and the Caribbean.(Sergio Aguilar-Gaxiola, MD, PhD is Professor of Clinical Internal Medicine, School of Medicine, University of California, Davis. He is the Founding Director of the Center for Reducing Health Disparities at UC Davis Health and the Director of the Community Engagement Program of the Clinical Translational Science Center (CTSC). He is currently a Member of the National Advisory Council of the Substance Abuse and Mental Health Administration (SAMHSA) Center for Mental Health Services since 2019 and a board member of the California Health Care Foundation. He is a national and international expert on health and mental health comorbidities on diverse populations. He has held several World Health Organization (WHO) and Pan American Health Organization (PAHO) advisory board and consulting appointments and is currently a member of the Executive Committee of the World Health Organization (WHO) World Mental Health Survey Consortium (WMH) and its Coordinator for Latin America and the Caribbean.)edit
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Individuals from low socioeconomic status (SES) backgrounds are more likely to experience negative health outcomes. The link between SES and health may be partially mediated by safety fears since perceptions of neighborhood conditions is... more
Individuals from low socioeconomic status (SES) backgrounds are more likely to experience negative health outcomes. The link between SES and health may be partially mediated by safety fears since perceptions of neighborhood conditions is linked to certain health outcomes. This study examined how SES is associated with health outcomes via the mediating effects of neighborhood safety concerns and physical activity. Data come from the California Health Interview Survey (CHIS) using a sample of 44,346 adults. Structural equation models indicated that the associations between SES and health outcomes appear to be partially mediated through concerns of neighborhood safety and physical activity, but differently for certain groups. Neighborhood safety's influence on physical activity was moderated by gender and age: older males with high safety fears reported less physical activity than older males with low safety fears, whereas older women reported similar levels of physical activity re...
In this paper we report on the process of translating five mental health outcome measures into Spanish and adapting them to Latino culture. The instruments considered are the World Health Organization-Disability Assessment Scale, the... more
In this paper we report on the process of translating five mental health outcome measures into Spanish and adapting them to Latino culture. The instruments considered are the World Health Organization-Disability Assessment Scale, the Burden Assessment Scale, the Family Burden Scale, Lehman's Quality of Life Interview and the Continuity of Care in Mental Health Services Interview. A systematic process of
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This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were... more
This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization''s composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); Sao Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the Un...
Aims Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise... more
Aims Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. Methods The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. Results Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset...
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Objectives. We used results generated from the first study of the National Institutes of Health Sentinel Network to understand health concerns and perceptions of research among underrepresented groups such as women, the elderly,... more
Objectives. We used results generated from the first study of the National Institutes of Health Sentinel Network to understand health concerns and perceptions of research among underrepresented groups such as women, the elderly, racial/ethnic groups, and rural populations. Methods. Investigators at 5 Sentinel Network sites and 2 community-focused national organizations developed a common assessment tool used by community health workers to assess research perceptions, health concerns, and conditions. Results. Among 5979 individuals assessed, the top 5 health concerns were hypertension, diabetes, cancer, weight, and heart problems; hypertension was the most common self-reported condition. Levels of interest in research participation ranged from 70.1% among those in the “other” racial/ethnic category to 91.0% among African Americans. Overall, African Americans were more likely than members of other racial/ethnic groups to be interested in studies requiring blood samples (82.6%), geneti...
Research Interests: Gerontology, Community Health, Health Equity, Public Health, Medicine, and 15 moreCommunity Health Workers, Humans, Needs Assessment, Biomedical Research, Female, Male, Middle Aged, Adult, Ethnic Group, American Journal of Public Health, Consumer Participation, Translational Medical Research, attitude to health, Sentinel surveillance, and Medical and Health Sciences
Objectives. We examined the association between substance use disorders and migration to the United States in a nationally representative sample of the Mexican population. Methods. We used the World Mental Health version of the Composite... more
Objectives. We examined the association between substance use disorders and migration to the United States in a nationally representative sample of the Mexican population. Methods. We used the World Mental Health version of the Composite International Diagnostic Interview to conduct structured, computer-assisted, face-to-face interviews with a cross-sectional sample of household residents aged 18 to 65 years who lived in Mexico in cities with a population of at least 2500 people in 2001 and 2002. The response rate was 76.6%, with 5826 respondents interviewed. Results. Respondents who had migrated to the United States and respondents who had family members who migrated in the United States were more likely to have used alcohol, marijuana, or cocaine at least once in their lifetime; to develop a substance use disorder; and to have a current (in the past 12 months) substance use disorder than were other Mexicans. Conclusions. International migration appears to play a large role in tran...
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Background Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the... more
Background Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. Methods Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment bei...
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Aims Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population... more
Aims Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. Methods IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. Results The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy prop...
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Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. A total of 25 542 adult respondents... more
Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments. Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general ...
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We tested whether positive selection on childhood predictors of adult mental and physical health contributed to health advantages of Mexican-born immigrants to the United States relative to U.S.-born Mexican Americans. We combined data... more
We tested whether positive selection on childhood predictors of adult mental and physical health contributed to health advantages of Mexican-born immigrants to the United States relative to U.S.-born Mexican Americans. We combined data from surveys conducted during 2000-2003 in Mexico and the U.S. with the same structured interview. We examined retrospective reports of childhood (i.e., < 16 years of age) predictors of adult health--education, height, childhood physical illness, childhood mental health, early substance use, and childhood adversities--as predictors of migration from Mexico to the U.S. at > or = 16 years of age. We estimated overall selection by comparing migrants to all non-migrants. We also examined selection at the family (members of families of migrants vs. members of families without a migrant) and individual (migrants vs. non-migrants within families of migrants) levels. Distinguishing between family and individual selection revealed evidence of positive he...
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Research Interests: Cognitive Science, Anxiety Disorders, Adolescent, Medicine, Humans, and 15 moreImpulse Control Disorders, Female, Male, Mental Disorders, Mental Disorder, Clinical Sciences, Mood Disorders, Aged, Middle Aged, Adult, Psychotic Disorders, Substance-Related Disorders, Age of Onset, Severity of Illness Index, and Phobic disorders
BackgroundPrevious community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.AimsTo explore mental health treatment drop out in the World Health Organization World Mental Health... more
BackgroundPrevious community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.AimsTo explore mental health treatment drop out in the World Health Organization World Mental Health Surveys.MethodRepresentative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted.ResultsOverall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower/middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit.ConclusionsDrop out ne...
Research Interests: Demography, Mental Health, Global Health, International, Adolescent, and 15 moreMedicine, Comorbidity, Humans, Northern Ireland, Income, Mental Disorders, Mental health services, Mental Health Care, Aged, Middle Aged, Adult, Health surveys, Ambulatory Care, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Objectives. We examined migration-related changes in smoking behavior in the transnational Mexican-origin population. Methods. We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States... more
Objectives. We examined migration-related changes in smoking behavior in the transnational Mexican-origin population. Methods. We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States (Collaborative Psychiatric Epidemiology Surveys). We compared 4 groups with increasing US contact with respect to smoking initiation, persistence, and daily cigarette consumption: Mexicans with no migrant in their family, Mexicans with a migrant in their family or previous migration experience, migrants, and US-born Mexican Americans. Results. Compared with Mexicans with a migrant in their family or previous migration experience, migrants were less likely to initiate smoking (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.38, 0.83) and less likely to be persistent smokers (OR = 0.41; 95% CI = 0.26, 0.63). Among daily smokers, the US-born smoked more cigarettes per day than did Mexicans with a migrant in their family or previous migration expe...
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Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Data were... more
Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was rough...
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Research Interests: Adolescent, Comorbidity, Humans, Child, Female, and 15 moreMale, Mental Disorders, ROC Curve, Aged, Prevalence, Middle Aged, Adult, Age Factors, Health surveys, Archives General Psychiatry, Age of Onset, Cohort Studies, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Adolescent, Comorbidity, Mexico, California, Immigrants, and 15 moreHumans, Face to Face, Female, Male, Mental Disorders, Mexican American, Mexican Americans, Middle Aged, Adult, Educational Status, MEXICO, Archives General Psychiatry, Marital Status, Medical and Health Sciences, and multivariate analyses
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Aims To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors... more
Aims To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Methods Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001–2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Results Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the v...
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Aims.A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity,... more
Aims.A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.Methods.In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety dis...
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While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using... more
While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. Lifetime occurrences of six types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ(2) = 190.1, P < 0.001) as well as greater likelihood of cognitive, social, and role impairment. Relationships persisted in each adjusted model. A significant dose-response relationship was also found f...
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Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that... more
Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR ...
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Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. The World... more
Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18-22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI). One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorder...
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We investigated the underlying mechanisms of the influence of socioeconomic status (SES) on mental health and self-rated health (SRH), and evaluated how these relationships might vary by race/ethnicity, age, and gender. We analyzed data... more
We investigated the underlying mechanisms of the influence of socioeconomic status (SES) on mental health and self-rated health (SRH), and evaluated how these relationships might vary by race/ethnicity, age, and gender. We analyzed data of 44 921 adults who responded to the 2009 California Health Interview Survey. We used a path analysis to test effects of SES, neighborhood safety, and physical activity on mental health and SRH. Low SES was associated with greater neighborhood safety concerns, which were negatively associated with physical activity, which was then negatively related to mental health and SRH. This model was similar across different racial/ethnic and gender groups, but mean levels in the constructs differed across groups. SES plays an important role in SRH and mental health, and this effect is further nuanced by race/ethnicity and gender. Identifying the psychological (neighborhood safety) and behavioral (physical activity) factors that influence mental health and SRH is critical for tailoring interventions and designing programs that can improve overall health.
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The end of the Cold War has marked a period when the U.S. military is asked to secure peace under conditions in which peace is tenuous, yet the need for resolution of the conflict is great. Combat-trained soldiers are highly visible and... more
The end of the Cold War has marked a period when the U.S. military is asked to secure peace under conditions in which peace is tenuous, yet the need for resolution of the conflict is great. Combat-trained soldiers are highly visible and are exposed to threats to their lives, yet are asked to exhibit restraint and neutrality. The psychiatric consequences of peace-keeping duty under these conflicting and volatile conditions have been underresearched. The authors examined the prevalence of posttraumatic stress disorder (PTSD) associated with exposure to peacekeeping duty in Somalia. A large cohort of active duty personnel deployed to Somalia (N = 3,461) were surveyed approximately 5 months after their return to the United States. A variety of military service characteristics and exposure variables and PTSD symptoms were examined. Eight percent of peacekeepers were found to meet diagnostic criteria for PTSD. PTSD symptom severity was best predicted by the rewards of military service, wa...
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In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year.... more
In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California.
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Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We... more
Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified b...
Research Interests: Psychology, Health Promotion, Health Education, Colorectal cancer, Self Efficacy, and 13 moreHumans, Philosophy and Religious Studies, Female, Male, Colonoscopy, Aged, Middle Aged, Randomized Controlled Trial, Colorectal Neoplasms, Sigmoidoscopy, Early detection of cancer, healthcare disparities, and Medical and Health Sciences
More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health... more
More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services. Childhood is a vital time for the promotion of positive mental health among children, as well as for supporting at-risk families in order to avert the early onset of some disorders and help reduce the severity of others. To reduce the potential burden and lifelong difficulties of untreated mental health needs, it is critical that mental health problems in young children be identified and addressed early.
Research Interests: Health Promotion, Health insurance, California, Humans, Child, and 13 moreMental Disorders, Mental health services, Risk factors, Health Status, Family Health, Health surveys, Risk Factors, Communication barriers, Insurance Coverage, Socioeconomic Factors, Child preschool, Health Services Accessibility, and Delivery of Health Care
The paper presents an overview of the WHO World Mental Health (WMH) Survey Initiative and summarizes recent WMH results regarding the prevalence and societal costs of mental disorders. The WMH surveys are representative community surveys... more
The paper presents an overview of the WHO World Mental Health (WMH) Survey Initiative and summarizes recent WMH results regarding the prevalence and societal costs of mental disorders. The WMH surveys are representative community surveys that were carried out in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, burden, and unmet need for treatment of common mental disorders. Results show that mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25(th)-75(th) percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, disruptive behavior, and substance disorders) is 18.1-36.1%. The IQR of 12-month prevalence estimates is 9.8-19.1%. Analysis of age-of-onset reports shows that many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Adult mental disorders are found in the WMH da...
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Research Interests: Epidemiology, Global Health, Asthma, International Cooperation, Adolescent, and 15 moreComorbidity, Cross-Cultural Comparison, Population, Humans, Female, Male, Young Adult, Mental Disorders, Aged, Middle Aged, Adult, Retrospective Studies, Psychiatric, Psychology and Cognitive Sciences, and Medical and Health Sciences
Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental... more
Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
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Research Interests: Adolescent, Comorbidity, Mexico, California, Immigrants, and 15 moreHumans, Face to Face, Female, Male, Mental Disorders, Mexican American, Mexican Americans, Middle Aged, Adult, Educational Status, MEXICO, Archives General Psychiatry, Marital Status, Medical and Health Sciences, and multivariate analyses
BackgroundThe treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent... more
BackgroundThe treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.MethodsData come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).ResultsOnly 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was p...
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Background Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent... more
Background Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. Methods The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. Results 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 m...
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November 2011 early two million adults in California have mental health needs, based on self-reported symptoms and impairments. Of these two million adults, approximately half reported receiving no mental health treatment in the past... more
November 2011 early two million adults in California have mental health needs, based on self-reported symptoms and impairments. Of these two million adults, approximately half reported receiving no mental health treatment in the past year, one-quarter received some ...