Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys.
Journal: World psychiatry : official journal of the World Psychiatric Association (WPA)
Volume: 21
Issue: 2
Year of Publication:
Affiliated Institutions:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Department of Psychology, Yale University, New Haven, CT, USA.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq.
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Núcleo de Epidemiologia Psiquiátrica - LIM , Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven, Leuven, Belgium.
School of Psychology, Ulster University, Londonderry, UK.
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA University of Lisbon, Lisbon, Portugal.
Anxiety Disorders Research Center, Buenos Aires, Argentina.
National School of Public Health, Management and Professional Development, Bucharest, Romania.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain.
School of Public Health, University of Queensland, Herston, and Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, China.
Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon.
Department of Mental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Psychology Research Unit for Public Health, WSB University, Torun, Poland.
Laboratoire de Psychopathologie et Processus de Santé EA , Université de Paris, Paris, France.
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
Institute of Psychiatry and Neurology, Warsaw, Poland.
Unidad de Docencia, Investigación y Formación en Salud Mental, Universidad de Murcia, Murcia, Spain.
Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia.
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia.
Departamento de Psiquiatría y Salud Mental, Universidad de Buenos Aires, Buenos Aires, Argentina.
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil.
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health - National Research Institute, Warsaw, Poland.
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.
Abstract summary
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
Authors & Co-authors:
Kessler Ronald C RC
Kazdin Alan E AE
Aguilar-Gaxiola Sergio S
Al-Hamzawi Ali A
Alonso Jordi J
Altwaijri Yasmin A YA
Andrade Laura H LH
Benjet Corina C
Bharat Chrianna C
Borges Guilherme G
Bruffaerts Ronny R
Bunting Brendan B
de Almeida José Miguel Caldas JMC
Cardoso Graça G
Chiu Wai Tat WT
Cía Alfredo A
Ciutan Marius M
Degenhardt Louisa L
de Girolamo Giovanni G
de Jonge Peter P
de Vries Ymkje Anna YA
Florescu Silvia S
Gureje Oye O
Haro Josep Maria JM
Harris Meredith G MG
Hu Chiyi C
Karam Aimee N AN
Karam Elie G EG
Karam Georges G
Kawakami Norito N
Kiejna Andrzej A
Kovess-Masfety Viviane V
Lee Sing S
Makanjuola Victor V
McGrath John J JJ
Medina-Mora Maria Elena ME
Moskalewicz Jacek J
Navarro-Mateu Fernando F
Nierenberg Andrew A AA
Nishi Daisuke D
Ojagbemi Akin A
Oladeji Bibilola D BD
O'Neill Siobhan S
Posada-Villa José J
Puac-Polanco Victor V
Rapsey Charlene C
Ruscio Ayelet Meron AM
Sampson Nancy A NA
Scott Kate M KM
Slade Tim T
Stagnaro Juan Carlos JC
Stein Dan J DJ
Tachimori Hisateru H
Ten Have Margreet M
Torres Yolanda Y
Viana Maria Carmen MC
Vigo Daniel V DV
Williams David R DR
Wojtyniak Bogdan B
Xavier Miguel M
Zarkov Zahari Z
Ziobrowski Hannah N HN
Study Outcome
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