TY - JOUR
T1 - Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
AU - Kessler, Ronald C.
AU - Kazdin, Alan E.
AU - Aguilar-Gaxiola, Sergio
AU - Al-Hamzawi, Ali
AU - Alonso, Jordi
AU - Altwaijri, Yasmin A.
AU - Andrade, Laura H.
AU - Benjet, Corina
AU - Bharat, Chrianna
AU - Borges, Guilherme
AU - Bruffaerts, Ronny
AU - Bunting, Brendan
AU - de Almeida, José Miguel Caldas
AU - Cardoso, Graça
AU - Chiu, Wai Tat
AU - Cía, Alfredo
AU - Ciutan, Marius
AU - Degenhardt, Louisa
AU - de Girolamo, Giovanni
AU - de Jonge, Peter
AU - de Vries, Ymkje Anna
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Haro, Josep Maria
AU - Harris, Meredith G.
AU - Hu, Chiyi
AU - Karam, Aimee N.
AU - Karam, Elie G.
AU - Karam, Georges
AU - Kawakami, Norito
AU - Kiejna, Andrzej
AU - Kovess-Masfety, Viviane
AU - Lee, Sing
AU - Makanjuola, Victor
AU - McGrath, John J
AU - Medina-Mora, Maria Elena
AU - Moskalewicz, Jacek
AU - Navarro-Mateu, Fernando
AU - Nierenberg, Andrew A.
AU - Nishi, Daisuke
AU - Ojagbemi, Akin
AU - Oladeji, Bibilola D.
AU - O'Neill, Siobhan
AU - Posada-Villa, José
AU - Puac-Polanco, Victor
AU - Rapsey, Charlene
AU - Ruscio, Ayelet Meron
AU - Sampson, Nancy A.
AU - Scott, Kate M.
AU - Xavier, Miguel
N1 -
Funding Information:
The WMH Survey collaborators are S. Aguilar‐Gaxiola, A. Al‐Hamzawi, J. Alonso, Y.A. Altwaijri, L.H. Andrade, L. Atwoli, C. Benjet, G. Borges, E.J. Bromet, R. Bruffaerts, B. Bunting, J.M. Caldas de Almeida, G. Cardoso, S. Chardoul, S. Chatterji, A. Cia, L. Degenhardt, K. Demyttenaere, S. Florescu, G. de Girolamo, O. Gureje, J.M. Haro, M.G. Harris, H. Hinkov, Chi‐Yi Hu, P. de Jonge, A.N. Karam, E.G. Karam, G. Karam, N. Kawakami, R.C. Kessler, A. Kiejna, V. Kovess‐Masfety, S. Lee, J.‐P. Lepine, J.J. McGrath, M.E. Medina‐Mora, J. Moskalewicz, F. Navarro‐Mateu, M. Piazza, J. Posada‐Villa, K.M. Scott, T. Slade, J.C. Stagnaro, D.J. Stein, M. ten Have, Y. Torres, M.C. Viana, D.V. Vigo, H. Whiteford, D.R. Williams and B. Wojtyniak. The WMH Survey Initiative has been supported by the US Public Health Service (grant nos. R01 MH070884, R13‐MH066849, R01‐MH069864, R01 DA016558, R03‐TW006481), the MacArthur Foundation, the Pfizer Foundation, the Pan American Health Organization, Eli Lilly and Company, Ortho‐McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol‐Myers Squibb. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The views and opinions expressed in this paper are those of the authors and should not be construed to represent the views of the WHO, other sponsoring organizations, agencies or governments. The authors are grateful to the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. R.C. Kessler and A.E. Kazdin are joint first authors of this paper.
Funding Information:
The WMH Survey collaborators are S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, Y.A. Altwaijri, L.H. Andrade, L. Atwoli, C. Benjet, G. Borges, E.J. Bromet, R. Bruffaerts, B. Bunting, J.M. Caldas de Almeida, G. Cardoso, S. Chardoul, S. Chatterji, A. Cia, L. Degenhardt, K. Demyttenaere, S. Florescu, G. de Girolamo, O. Gureje, J.M. Haro, M.G. Harris, H. Hinkov, Chi-Yi Hu, P. de Jonge, A.N. Karam, E.G. Karam, G. Karam, N. Kawakami, R.C. Kessler, A. Kiejna, V. Kovess-Masfety, S. Lee, J.-P. Lepine, J.J. McGrath, M.E. Medina-Mora, J. Moskalewicz, F. Navarro-Mateu, M. Piazza, J. Posada-Villa, K.M. Scott, T. Slade, J.C. Stagnaro, D.J. Stein, M. ten Have, Y. Torres, M.C. Viana, D.V. Vigo, H. Whiteford, D.R. Williams and B. Wojtyniak. The WMH Survey Initiative has been supported by the US Public Health Service (grant nos. R01 MH070884, R13-MH066849, R01-MH069864, R01 DA016558, R03-TW006481), the MacArthur Foundation, the Pfizer Foundation, the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The views and opinions expressed in this paper are those of the authors and should not be construed to represent the views of the WHO, other sponsoring organizations, agencies or governments. The authors are grateful to the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. R.C. Kessler and A.E. Kazdin are joint first authors of this paper.
Publisher Copyright:
© 2022 World Psychiatric Association.
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - anxiety disorders
KW - Helpfulness of treatment
KW - heterogeneity of treatment effects
KW - mood disorders
KW - patient-centered care
KW - post-traumatic stress disorder
KW - precision psychiatry
KW - professional help-seeking
KW - substance use disorders
KW - treatment adherence
UR - http://www.scopus.com/inward/record.url?scp=85131353890&partnerID=8YFLogxK
U2 - 10.1002/wps.20971
DO - 10.1002/wps.20971
M3 - Article
AN - SCOPUS:85131353890
SN - 1723-8617
VL - 21
SP - 272
EP - 286
JO - World Psychiatry
JF - World Psychiatry
IS - 2
ER -
