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

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 Sao 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.