Pathways to effective care for mental and substance use disorders in the World Mental Health Surveys. Part I: Perceived need for treatment

Background: Perceiving a need for treatment is a first step in the pathway to effective mental health care. Perceived need encompasses an individual’s judgements about: whether they have a problem; and whether they need professional help to manage the problem. These two components could have different predictors.
Methods: Respondents aged 18+ years with 12-month mental and substance use disorders were from 25 representative household surveys in 21 countries in the World Health Organization’s (WHO’s) World Mental Health Survey Initiative (n=12,508). All surveys included questions about perceived need; 16 surveys (13 countries) included additional questions enabling decomposition (n=9,814). Associations of three sets of predictors (disorder, socio-demographics, past treatment) with overall perceived need and its components were examined using Poisson regression models.
Results: Across the 16 surveys with additional questions, 42.4% of respondents reported perceived need. Among those without perceived need, 54.4% did not think they had a problem and 45.6% thought they could handle the problem on their own. In separate models for each predictor set: (1) Most disorder types (except specific phobia and alcohol use disorder) predicted higher probability of perceived need and of both components, as did disorder severity, and number of disorders (albeit at a diminishing rate for each additional disorder); (2) Sociodemographic factors tended to differentially predict either problem recognition (females, 30-59 years, disabled/unemployed) or need for professional help (females, homemakers, disabled/unemployed, public insurance); (3) Past treatment (provider type, psychotherapy, helpful or unhelpful treatment) predicted perceived need and both components, while number of providers seen differentially predicted problem recognition (at a diminishing rate for each additional provider seen). In a consolidated model: employment, insurance and treatment type became non-significant; type and number of providers seen became more important; helpful treatment predicted problem recognition while unhelpful treatment predicted need for professional help; and associations were more due to problem recognition than need for professional help.
Conclusions: Increasing perceived need may require a dual focus on problem recognition and attitudes to treatment. Net of disorder and demographic factors, perceived need was conditional on past treatment factors including perceived helpfulness; this highlights treatment experiences as important enablers of future help-seeking.