Abstract
Objectives: To 1) examine the prevalence of common and high-burden mental illnesses in the community, including depressive disorders, psychotic symptoms and alcohol and substance use disorders; 2) investigate social factors associated with mental disorders; and 3) describe what proportions of mentally ill individuals had limited or no access to services and associated barriers. Methods: Mixed method, including cross-sectional community survey and qualitative designs, was employed. The cross-sectional survey sampled without replacement residents aged 18 or over living in households within the Municipalities of Kukot and Lumsamkaew of Prathumthni Province. Face-to-face interviews were conducted by trained interviewers using the World Mental Health – Composite International Diagnostic Interview version 3.0 (WMH-CIDI 3.0) – Thai version, divided into 2 parts. The first part elicited diagnoses based on DSM-IV criteria. The second consisted of questions on sociodemographic background, history of service use, health coverage and earnings. The qualitative component consisted of in-depth interviews with mental health professionals about barriers to care and proposed solutions. Results: A total of 5,698 households in the selected municipalities were approached. The response rate was 69.1% (N=3,940). There were 3,877 interviews completed for analysis. Psychological distress had a one-year prevalence of 6.5%, psychotic symptoms 0.8%, alcohol use disorders 0.9% and substance use disorders 0.3%. Socio-economic status (measured by the Household Asset Index) was not associated with mental illness. Only 4.1% of those who reported having had mental illness in the past year had sought advice or treatment in the same period. Having mental problems in the past year was significantly associated with reduced or no earnings. A history of mental illness, with no current or recent active symptoms, was not significantly associated with reduced or no earnings. Conclusions: The prevalence rates of mental illnesses in Prathumthani Province were similar to those reported in the recent mental health survey in Bangkok. The figures were also comparable to those reported in many East Asian countries, but relatively low compared with those found in Western countries. Reducing treatment gap in mental health care is likely to substantially ease economic burden because, if well-treated, mentally ill people can get back to work and earn incomes. Certain measures such as improving mental health literacy and developing alternative care models may help narrow the gap in accessing mental health care.
