Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report.
Journal: BMC psychiatry
Volume: 21
Issue: 1
Year of Publication: 2021
Affiliated Institutions:
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. dan.stein@uct.ac.za.
Department of Psychology, Yale University, New Haven, CT, USA.
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, 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.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
School of Psychology, Ulster University, Londonderry, UK.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Department of Developmental Psychology, University of Groningen, Groningen, Netherlands.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
School of Public Health, The University of Queensland, Herston, QLD, , Australia.
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon.
Ecole des Hautes Etudes en Santé Publique (EHESP), EA , Paris Descartes University, Paris, France.
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
National Institute of Psychiatry-Ramón de la Fuente Muñiz, Mexico City, Mexico.
Institute of Psychiatry and Neurology, Warsaw, Poland.
UDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Murcia, Spain.
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia.
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
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.
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.
Abstract summary
Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment.Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment.The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness.The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.
Authors & Co-authors:
Stein Dan J DJ
Kazdin Alan E AE
Ruscio Ayelet Meron AM
Chiu Wai Tat WT
Sampson Nancy A NA
Ziobrowski Hannah N HN
Aguilar-Gaxiola Sergio S
Al-Hamzawi Ali A
Alonso Jordi J
Altwaijri Yasmin Y
Bruffaerts Ronny R
Bunting Brendan B
de Girolamo Giovanni G
de Jonge Peter P
Degenhardt Louisa L
Gureje Oye O
Haro Josep Maria JM
Harris Meredith G MG
Karam Aimee A
Karam Elie G EG
Kovess-Masfety Viviane V
Lee Sing S
Medina-Mora Maria Elena ME
Moskalewicz Jacek J
Navarro-Mateu Fernando F
Nishi Daisuke D
Posada-Villa José J
Scott Kate M KM
Viana Maria Carmen MC
Vigo Daniel V DV
Xavier Miguel M
Zarkov Zahari Z
Kessler Ronald C RC
Study Outcome
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