Patterns and predictors of 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys: treatment in the context of perceived need.
Journal: International journal of mental health systems
Volume: 19
Issue: 1
Year of Publication:
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, Rondebosch, Cape Town, , ZA, South Africa.
Department of Psychiatry, University of British Columbia, UBC Hospital-Detwiller Pavilion, Room , Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, VT A, Canada.
School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag , Archerfield, QLD, , Australia.
Department of Psychology, Yale University, Hillhouse Avenue, , New Haven, CT, , USA.
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, /, Vitoria, Espirito Santo-ES, -, Brazil.
Department of Health Care Policy, Harvard Medical School, Longwood Avenue, Boston, MA, , USA.
The Watson Institute for International and Public Affairs, Brown University, Providence, RI, United States.
IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, , , Barcelona, Spain.
University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica-LIM , Rua dr. Ovidio Pires de Campos, , São Paulo, CEP, -, Brazil.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco , Col San Lorenzo Huipulco, CDMX , Mexico City, Mexico.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, UZ Herestraat , Box , , Louvain, Belgium.
School of Psychology, Ulster University, Coleraine Campus, Coleraine, BT SA, UK.
Lisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua do Instituto Bacteriológico, , -, Lisbon, Portugal.
Survey Research Center, Institute for Social Research, University of Michigan, Packard, Room G, Ann Arbor, MI, , USA.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni , Brescia, Italy.
Department of Developmental Psychology, University of Groningen, Grote Kruisstraat /, TS, Groningen, The Netherlands.
Department of Psychiatry, University of Ibadan, University College Hospital, PMB , Ibadan, Nigeria.
CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, -, Pabellón , Planta , , Madrid, Spain.
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
Institut de Psychologie, UR , Université Paris Cité, Avenue Édouard Vaillant, , Boulogne Billancourt, Paris, France.
Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego , -, Warsaw, Poland.
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, --, Hongo, Bunkyo-ku, Tokyo, -, Japan.
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Calle # B , , Bogotá, Colombia.
Department of Psychological Medicine, University of Otago, PO Box , Dunedin, , New Zealand.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Paraguay , Ciudad Autónoma de Buenos Aires, Argentina.
National Institute for Health Services Management, Strada Vaselor , , Bucharest, Romania.
Department of Mental Health, National Center of Public Health and Analyses, , Acad. Ivan Geshov Blvd., Sofia, , Bulgaria.
Department of Health Care Policy, Harvard Medical School, Longwood Avenue, Boston, MA, , USA. kessler@hcp.med.harvard.edu.
Abstract summary
Data from the World Mental Health (WMH) surveys on the coverage cascade has underscored the importance of perceived need for seeking treatment of mental disorders. However, little research has focused on treatment contact after adjusting for perceived need. We do so here in analysis of WMH data.The WMH data considered here come from 25 community surveys implemented between 2001 and 2019 across 21 countries. n = 12,508 of the n = 117,739 respondents in these surveys aged 18 and older met criteria for one or more 12-month DSM-IV anxiety, mood, or substance use disorders assessed across all these surveys. Information was obtained about 12-month treatment of each disorder. The predictors considered were disorder type, socio-demographics, and history of prior treatment.Twelve-month treatment was obtained for 17.7% of the n = 18,702 12-month person-disorders in the sample, including 34.1% for the 46.5% with perceived need and 3.5% for the 54.5% without perceived need. After adjusting for perceived need, receiving treatment was most strongly associated with disorder characteristics (severity, and highest for major depressive, panic/agoraphobia, and generalized anxiety disorders; lowest for substance use disorders), health insurance, employment status (highest for students, the retired, and the unemployed/disabled), and several aspects of prior treatment. These associations were generally similar in cases with and without perceived need for treatment. 12-month treatment among cases who without perceived need and without history of prior treatment was rare (1.1%).Findings highlight the critical importance of perceived need for obtaining 12-month treatment in the context of other significant predictors involving complexity and severity of disorders and socio-demographic factors. The importance of prior treatment history was quite striking, as was the finding that absence of both perceived need and prior treatment history were associated with a nearly complete absence of treatment. Policy recommendations emerging from these results include the need to increase health literacy, reduce the stigmatization of mental disorder, enhance access through health insurance, and improve the quality of care given the clear evidence that prior experiences with treatment play an important role in determining the likelihood of again seeking treatment for current problems.
Authors & Co-authors:
Stein Dan J DJ
Vigo Daniel V DV
Harris Meredith G MG
Kazdin Alan E AE
Viana Maria Carmen MC
Hwang Irving I
Kessler Timothy L TL
Manoukian Sophie M SM
Sampson Nancy A NA
Alonso Jordi J
Andrade Laura Helena LH
Benjet Corina C
Bruffaerts Ronny R
Bunting Brendan B
Cardoso Graça G
Chardoul Stephanie S
de Girolamo Giovanni G
de Jonge Peter P
Gureje Oye O
Haro Josep Maria JM
Karam Elie G EG
Kovess-Masfety Viviane V
Moskalewicz Jacek J
Navarro-Mateu Fernando F
Nishi Daisuke D
Posada-Villa José J
Scott Kate K
Stagnaro Juan Carlos JC
Vladescu Cristian C
Wciórka Jacek J
Zarkov Zahari Z
Kessler Ronald C RC
Study Outcome
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