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Published Online: 30 August 2023

Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990–2020

Adrian P. Mundt, M.D., Ph.D. [email protected], Sabine Delhey, M.A., Pablo Martínez, Ph.D., Matías Irarrázaval, M.D., M.P.H., Luciano Grasso, Guillermo Rivera-Arroyo, M.D., Ph.D., Adelia Capistrano, M.Sc., Natalia Trujillo, Ph.D., Francisco Golcher, M.D., M.P.H., Andrés Benavides Salcedo, M.P.H., Corinne Dedik, Martha Cordero, M.D., Julio Torales, M.D., Ph.D., César Malpartida, and Ángel Almánzar, M.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 1
https://doi.org/10.1176/appi.ps.20220590
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Abstract

Objective:

Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990–2020 period.

Methods:

The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities.

Results:

Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (−42%) and in general hospitals from 1.0 to 0.8 (−24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%).

Conclusions:

The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

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Supplementary Material

File (appi.ps.20220590.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 1 • January 01, 2024
Pages: 48 - 54
PubMed: 37644830

History

Received: 20 November 2022
Revision received: 18 March 2023
Revision received: 8 May 2023
Accepted: 19 May 2023
Published online: 30 August 2023
Published in print: January 01, 2024

Keywords

  1. Latin America
  2. Psychiatric hospital beds
  3. Psychiatric reforms
  4. Mental health systems
  5. Medical-psychiatric units

Authors

Affiliations

Adrian P. Mundt, M.D., Ph.D. [email protected]
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Sabine Delhey, M.A.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Pablo Martínez, Ph.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Matías Irarrázaval, M.D., M.P.H.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Luciano Grasso
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Guillermo Rivera-Arroyo, M.D., Ph.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Adelia Capistrano, M.Sc.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Natalia Trujillo, Ph.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Francisco Golcher, M.D., M.P.H.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Andrés Benavides Salcedo, M.P.H.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Corinne Dedik
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Martha Cordero, M.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Julio Torales, M.D., Ph.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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César Malpartida
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Ángel Almánzar, M.D.
School of Medicine, Universidad Diego Portales, Santiago, Chile (Mundt, Delhey); Clínica Alemana, Universidad del Desarrollo School of Medicine, Santiago, Chile (Mundt); School of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada (Martínez); Charles-Le Moyne Research Center on Health Innovations, Longueuil, Québec, Canada (Martínez); Pan American Health Organization, Washington, D.C. (Irarrázaval); Department of Mental Health and Addiction, Ministry of Public Health, Buenos Aires (Grasso); Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia (Rivera-Arroyo); General Coordination of Mental Health, Alcohol, and Other Drugs, Ministry of Health, São Paulo, Brazil (Capistrano); Mental Health Group, National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia (Trujillo); Department of Psychiatry and Mental Health, Ministry of Public Health, San José, Costa Rica (Golcher); Ministry of Public Health, Quito, Ecuador (Benavides Salcedo); National Economic Research Center, Guatemala City (Dedik); Center for Global Mental Health Research, Ramón de la Fuente Muńiz National Institute of Psychiatry, Mexico City (Cordero); Department of Psychiatry, Universidad Nacional de Asunción, San Lorenzo, Paraguay (Torales); Regional Institute for Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay (Torales); Ministry of Health, Lima, Peru (Malpartida); Department of Psychiatry and Mental Health, Ministry of Public Health, Santo Domingo, Dominican Republic (Almánzar).
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Notes

Send correspondence to Dr. Mundt ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This study was funded by the Chilean Agencia Nacional de Ivestigación y Desarrollo (ANID; grant Fondo Nacional de Desarrollo Científico y Tecnológico Regular 1190613), the Millennium Science Initiative and Millennium Institute for Research on Depression and Personality (ICS13 005 to Dr. Martínez), the Nature and Technology Research Fund Québec (PBEEE 319091 to Dr. Martínez), and the Psicomedica Clinical and Research Group (to Dr. Martínez). The authors thank Carolina Padilla, Ariel Montalban, M.D., Ricardo Goti, M.D., Nicolás Martínez López, M.D., and Ana Fresan Orellana, M.D., for contributing to the data collection for this study and critically revising a draft of the article.ANID had no involvement in the study design, data collection, analysis and interpretation of the data, writing of the report, or decision to submit the article for publication. The authors declare sole responsibility for the views expressed in this article, which may not necessarily reflect the opinion or policy of the Pan American Health Organization or the World Health Organization.

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