摘要：Objectives. We studied failure and delay in making initial treatment contact after the first onset of a mental or substance use disorder in Mexico as a first step to understanding barriers to providing effective treatment in Mexico. Methods. Data were from the Mexican National Comorbidity Survey (2001–2002), a representative, face-to-face household survey of urban residents aged 18 to 65 years. The age of onset for disorders was compared with the age of first professional treatment contact for each lifetime disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ). Results. Many people with lifetime disorders eventually made treatment contact, although the proportions varied for mood (69.9%), anxiety (53.2%), and substance use (22.1%) disorders. Delays were long: 10 years for substance use disorders, 14 years for mood disorders, and 30 years for anxiety disorders. Failure and delay in making initial treatment contact were associated with earlier ages of disorder onset and being in older cohorts. Conclusions. Failure to make prompt initial treatment contact is an important reason explaining why there are unmet needs for mental health care in Mexico. Meeting these needs will likely require expansion and optimal allocation of resources as well as other interventions. Mental and substance use disorders account for enormous burdens worldwide. In developing countries, these disorders are already leading causes of disability and their number is expected to increase. 1 Many affected individuals in both developed and developing countries fail to receive effective treatment; determining the reasons for this failure is imperative. 2 An essential first step in obtaining effective treatment is making prompt contact with a health care provider after the first onset of a mental or substance use disorder. 3 , 4 Unfortunately, little is known about the barriers people face in taking this crucial first step. The few studies of this issue have found that although approximately 80% of people with mental disorders eventually make treatment contact, they typically delay for a decade. 5 , 6 These troubling results come from studies that examined the United States 6 , 7 and other developed countries. 8 , 9 The situation may be far worse in developing countries such as Mexico. 10 Indirect evidence supporting this possibility comes from a 2004 Pan-American Health Organization report that documented Mexico’s widespread lack of mental health services and limited treatment options even when services were available. 11 Initial results from the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative being implemented in developed and developing countries worldwide showed that respondents in Mexico had one of the lowest rates of prevalence of mental health service use (4.2% vs 15.3% in the United States) among the countries studied. 2 A more detailed analysis found that fewer than 1 in 5 respondents with a current, active psychiatric disorder during the previous 12 months used any services during the same period, and only 1 in every 2 of those who used services received care that met minimal standards for adequacy. 12 We used data from the recent Mexican National Comorbidity Survey 13 to examine the extent to which people with mental and substance use disorders fail and delay in seeking initial treatment. We hypothesized that the situation in a developing country such as Mexico would be worse than that observed in developed countries such as the United States and would illustrate the urgency of intervening to ensure that individuals in need receive prompt and effective initial treatment.
