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If the information was not readily pre- sented in a table, it was extrapolated from the data presented in the reports. For Canada (28), Chile (29), and Guate- mala (30), the data files were obtained from the investigators (Canada public domain) and analyzed with SUDAAN (Research Triangle Institute, Raleigh, North Carolina, United States) using the appropriate weights to account for the national census and the sample design. The 12-month treatment rate was used for all countries except Chile, which used a 6-month rate. Severity of mental disor- ders for the WMHS was based on the Sheehan Disability Scale (31). For Can- ada, Chile, and Guatemala, the severity of mental disorders was rated with an index based on the diagnosis and the ex- tent of comorbidity (29, 32). Estimates of the treatment gap for the Americas and subregions were calculated by the mean and median across studies, as well as a weighted mean. The weighted average took into account each country’s popula- tion (1); unlike the mean and median estimates, which did not distinguish among countries based on population size. In addition, the weighted 12-month prevalence of those without treatment by subregion was estimated. Treatment gaps were also examined for children and adolescents and the in- digenous population. For the Chile study ( n = 1 558, age 4 – 18 years), based on four provinces representing all major geo- graphic areas, parents were interviewed on behalf of children 4 – 11 years of age; only the adolescent was interviewed in the group 12 –18 years of age; and sever- ity of disorders was based on the DISC severity criteria (33, 34). In the Puerto Rico study ( n = 1 886, age 4 – 17 years), a nationally representative sample, both child and parent were interviewed and the Children’s Global Assessment Scale (CGAS; 35, 36) was used. In the two CIDI-Adolescent Supplement studies in Mexico ( n = 3 005, age 12 – 17 years) and the United States ( n = 10 123, age 13 – 18 years), only the adolescent was interviewed (37 – 39). Severity of mental
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Rev Panam Salud Publica 42, 2018 3 Kohn et al. • Treatment gaps in mental health care Original research disorders was measured using the Shee- han Disability Scale in Mexico (37) and the CGAS in the United States (38, 39). The Mexico survey was limited to Mex- ico City. The nationally representative study of the United States used lifetime service utilization (40), while the other studies were based on 12-month service utilization. The 12-month prevalence rates were used for all of the child and adolescent studies. Studies providing prevalence and ser- vice utilization of indigenous populations in the Americas were obtained from Chile ( n = 75, age 15 years; 43), Guatemala ( n = 409, age 15 – 65 years; 30), and the United States (41, 42)—based on a study of two indigenous tribal groups ( n = 3 084, age 15 – 54 years) and a nationally repre- sentative sample of American Indians and Alaska natives ( n = 701, age 18 years).
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