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 Jonge; Ymkje 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

doi:10.1002/wps.20971

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 Jonge

Ymkje 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

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

68 Downloads (Pure)

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 language	English
Pages (from-to)	272-286
Number of pages	15
Journal	World Psychiatry
Volume	21
Issue number	2
Early online date	7 May 2022
DOIs	https://doi.org/10.1002/wps.20971
Publication status	Published (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.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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

Access to Document

10.1002/wps.20971

COMPILED Kessler et al. Patterns and correlates of patient-reported helpfulnessAuthor Accepted Manuscript, 274 KB

Cite this

Kessler, R. C., Kazdin, A. E., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Altwaijri, Y. A., Andrade, L. H., Benjet, C., Bharat, C., Borges, G., Bruffaerts, R., Bunting, B., de Almeida, J. M. C., Cardoso, G., Chiu, W. T., Cía, A., Ciutan, M., Degenhardt, L., de Girolamo, G., ... Ziobrowski, H. N. (2022). Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys. World Psychiatry, 21(2), 272-286. https://doi.org/10.1002/wps.20971

@article{18893e2e4d72495cb106802dd4303fe2,

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

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.",

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",

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

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. {\textcopyright} 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: {\textcopyright} 2022 World Psychiatric Association. {\textcopyright} 2022 World Psychiatric Association.",

year = "2022",

month = jun,

day = "1",

doi = "10.1002/wps.20971",

language = "English",

volume = "21",

pages = "272--286",

journal = "World Psychiatry",

issn = "2051-5545",

publisher = "John Wiley and Sons Inc.",

number = "2",

}

Kessler, RC, Kazdin, AE, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Altwaijri, YA, Andrade, LH, Benjet, C, Bharat, C, Borges, G, Bruffaerts, R, Bunting, B, de Almeida, JMC, Cardoso, G, Chiu, WT, Cía, A, Ciutan, M, Degenhardt, L, de Girolamo, G, de Jonge, P, de Vries, YA, Florescu, S, Gureje, O, Haro, JM, Harris, MG, Hu, C, Karam, AN, Karam, EG, Karam, G, Kawakami, N, Kiejna, A, Kovess-Masfety, V, Lee, S, Makanjuola, V, McGrath, JJ, Medina-Mora, ME, Moskalewicz, J, Navarro-Mateu, F, Nierenberg, AA, Nishi, D, Ojagbemi, A, Oladeji, BD, O'Neill, S, Posada-Villa, J, Puac-Polanco, V, Rapsey, C, Ruscio, AM, Sampson, NA, Scott, KM, Slade, T, Stagnaro, JC, Stein, DJ, Tachimori, H, ten Have, M, Torres, Y, Viana, MC, Vigo, DV, Williams, DR, Wojtyniak, B, Xavier, M, Zarkov, Z & Ziobrowski, HN 2022, 'Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys', World Psychiatry, vol. 21, no. 2, pp. 272-286. https://doi.org/10.1002/wps.20971

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 - Slade, Tim

AU - Stagnaro, Juan Carlos

AU - Stein, Dan J.

AU - Tachimori, Hisateru

AU - ten Have, Margreet

AU - Torres, Yolanda

AU - Viana, Maria Carmen

AU - Vigo, Daniel V.

AU - Williams, David R.

AU - Wojtyniak, Bogdan

AU - Xavier, Miguel

AU - Zarkov, Zahari

AU - Ziobrowski, Hannah N.

N1 - 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.

PY - 2022/6/1

Y1 - 2022/6/1

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 - Helpfulness of treatment

KW - professional help-seeking

KW - heterogeneity of treatment effects

KW - patient-centered care

KW - treatment adherence

KW - mood disorders

KW - anxiety disorders

KW - posttraumatic stress disorder

KW - substance use disorders

KW - precision psychiatry

KW - post-traumatic stress disorder

KW - treatment adherence

U2 - 10.1002/wps.20971

DO - 10.1002/wps.20971

M3 - Article

C2 - 35524618

SN - 2051-5545

VL - 21

SP - 272

EP - 286

JO - World Psychiatry

JF - World Psychiatry

IS - 2

ER -

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

Abstract

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