Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

Ronald C Kessler, Alan E Kazdin, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Yasmin A Altwaijri, Laura H Andrade, Corina Benjet, Chrianna Bharat, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas de Almeida, Graça Cardoso, Wai Tat Chiu, Alfredo Cía, Marius Ciutan, Louisa Degenhardt, Giovanni de Girolamo, Peter de JongeYmkje Anna de Vries, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G Harris, Chiyi Hu, Aimee N Karam, Elie G Karam, Georges Karam, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, John J McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Andrew A Nierenberg, Daisuke Nishi, Akin Ojagbemi, Bibilola D Oladeji, Siobhan O'Neill, José Posada-Villa, Victor Puac-Polanco, Charlene Rapsey, Ayelet Meron Ruscio, Nancy A Sampson, Kate M Scott, Tim Slade, Juan Carlos Stagnaro, Dan J. Stein, Hisateru Tachimori, Margreet ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V. Vigo, David R. Williams, Bogdan Wojtyniak, Miguel Xavier, Zahari Zarkov, Hannah N. Ziobrowski

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Abstract

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.
Original languageEnglish
Pages (from-to)272-286
Number of pages15
JournalWorld Psychiatry
Volume21
Issue number2
Early online date7 May 2022
DOIs
Publication statusPublished (in print/issue) - 1 Jun 2022

Bibliographical note

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.

© 2022 World Psychiatric Association.

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.

© 2022 World Psychiatric Association.

Keywords

  • Helpfulness of treatment
  • professional help-seeking
  • heterogeneity of treatment effects
  • patient-centered care
  • treatment adherence
  • mood disorders
  • anxiety disorders
  • posttraumatic stress disorder
  • substance use disorders
  • precision psychiatry
  • post-traumatic stress disorder
  • treatment adher­ence

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