Mental health contact gaps among adults in Peru: a cross-sectional analysis of a nationally representative survey

Objective. To estimate lifetime and 12 month mental health contact gaps among Peruvian adults with survey-defined mental disorders, and to describe inequalities in contact, perceived need for care, and mental health service use. Methods. We analyzed the information for adults of the 2022 Peruvian National Mental Health Survey, a cross-sectional household survey. The primary outcome was the survey-weighted proportion of adults with a 12 month mental disorder who reported no contact with an included source of mental health-related care during that period; the lifetime contact gap was descriptive. Perceived need was assessed using two derived 12 month perceived-need measures based on direct ENSM variables and service contact routing items. Analyses incorporated weights, strata, and clusters. Adjusted prevalence ratios were estimated using survey weighted Poisson models. Results. The dataset contained information on 13,840 individuals; 13,833 had complete survey-design information. Contact gap denominators were 3,927 for lifetime disorders and 1,649 for 12-month disorders. The lifetime and 12-month contact gaps were 61.0% (95% CI 58.4-63.7) and 84.5% (95% CI 81.5-87.6), respectively. Rural estimates exceeded urban estimates in both periods; after adjustment, poverty and rural residence were associated with the lifetime gap, and extreme poverty with the 12-month gap. Among individuals meeting survey-based criteria for one or more 12-month mental disorders, 37.3% (95% CI 33.4-41.4) reported self-perceived need, whereas 25.6% (95% CI 21.8-29.8) reported that need had been identified by others. Annual psychological and psychiatric service use was 3.7% and 1.1%, respectively. Conclusions. Mental health contact gaps were high, particularly for one or more 12-month mental disorders, and were associated with social and territorial variables. These contact measures do not establish adequate, continuous, or effective treatment, which needs to be addressed to understand the impact of the Peruvian mental health reform.