Dsm iv and the 12 month treatment rates were used in

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DSM-IV and the 12-month treatment rates were used in all, except Chile which used DSM-III-R and a 6-month treatment rate. The 12-month prevalence rates were used for each of the studies. The data presented on the Mapuche in Chile (43) and the Maya in Guatemala was obtained from analysis of data files provided by the investigators. RESULTS Global burden of mental disorders Mental and substance use disorders account for 10.5% of the DALYs in the Americas (Table 1). Among children, 5.2% of all DALYs are due to mental and substance use disorders, whereas among those 15 – 59 years of age, the rate is 16.6%. Mental health and substance use disorders account for 22.0% of YLDs in the Americas and 28.5% among those 15 – 59 years of age. North America has a markedly higher GBD associated with mental health and substance use disor- ders than does Latin America and the Caribbean (LAC). Among those 15 – 59 years of age, there were notable differences in DALYs and YLDs between North America and LAC : DALYs for schizophrenia were 1.3 versus 0.9; alcohol use disorders, 2.0 versus 2.1; drug use disorders, 7.7 versus 1.7; depressive disorders, 4.8 versus 3.0; bipolar disorders, 0.9 versus 1.2; and anxiety disorders, 3.0 versus 2.4. The YLDs for schizophrenia were 2.2 versus 1.8; alcohol use disorders, 2.2 versus 3.0; drug use disorders, 8.2 versus 2.5; de- pressive disorders, 8.5 versus 6.4; bipolar disorders, 1.6 versus 2.6; and anxiety disorders, 5.2 versus 5.1. Prevalence of mental disorders The prevalence of mental disorders across the Americas varies consider- ably depending on the study: the 12-month prevalence range ranged from 7.2% in Guatemala to 29.6% in Brazil. The rate of severe mental disor- ders ranged from 2.0% in Guatemala to 10.0% in Brazil ( Table 2). The weighted mean 12-month prevalence of mental disorders in the Americas was 17.0%; North America, 22.5%; Latin America, 14.8%; Mesoamerica, 9.7%; and South America, 17.0%. Table 3 presents the rates by subregions for anxiety, affec- tive, and substance use disorders and by severity. Treatment gap A summary of mental health services utilization by type of provider is pre- sented in Table 4. The weighted mean for the treatment gap in the Americas for any mental disorder was 71.2%; for se- vere disorders, 57.6%; and for severe to moderate disorders, 65.7%. The treat- ment gap for severe mental disorders in North America was 40.5%; Latin America, 69.9%; Mesoamerica, 77.4%; and South America, 66.8%. For severe to moderate disorders, the treatment gap increased substantially; North America, 53.2%; Latin America, 74.7%; Meso- america, 78.7%; and South America, 73.1% (Table 5). Substance use disorders had the highest treatment gap in the Americas. In Latin America, the treat- ment gap for substance use disorders was 83.7% compared to 69.1% for North America. The treatment gap for anxiety disorders ranged from 56.2% in North America to 81.8% in Mesoamerica. For affective disorders, the treatment gap was 58.4% in North America and 77.4% in Mesoamerica.
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