Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey

Alan E. Kazdin; Julia R. Pozuelo; Meredith G. Harris; Dan J. Stein; Maria Carmen Viana; Irving Hwang; Timothy L. Kessler; Sophie M. Manoukian; Nancy A. Sampson; Sergio Aguilar-Gaxiola; Jordi Alonso; Laura Helena Andrade; Olatunde O. Ayinde; Guilherme Borges; Ronny Bruffaerts; Brendan Bunting; Graça Cardoso; Stephanie Chardoul; Cristina Domenech; Oye Gureje; Elie G. Karam; Viviane Kovess-Masfety; Fernando Navarro-Mateu; Daisuke Nishi; José Posada-Villa; Charlene Rapsey; Annelieke M. Roest; Juan Carlos Stagnaro; Yolanda Torres; Cristian Vladescu; Jacek Wciórka; Bogdan Wojtyniak; Zahari Zarkov; Ronald C. Kessler; Daniel V. Vigo

doi:10.1186/s13033-026-00698-w

Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey

Alan E. Kazdin
, Julia R. Pozuelo
, Meredith G. Harris
, Dan J. Stein
, Maria Carmen Viana
, Irving Hwang
, Timothy L. Kessler
, Sophie M. Manoukian
, Nancy A. Sampson
, Sergio Aguilar-Gaxiola
, Jordi Alonso
, Laura Helena Andrade
, Olatunde O. Ayinde
, Guilherme Borges
, Ronny Bruffaerts
, Brendan Bunting
, Graça Cardoso
, Stephanie Chardoul
, Cristina Domenech
, Oye Gureje

Elie G. Karam, Viviane Kovess-Masfety, Fernando Navarro-Mateu, Daisuke Nishi, José Posada-Villa, Charlene Rapsey, Annelieke M. Roest, Juan Carlos Stagnaro, Yolanda Torres, Cristian Vladescu, Jacek Wciórka, Bogdan Wojtyniak, Zahari Zarkov, Ronald C. Kessler, Daniel V. Vigo

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

2 Downloads (Pure)

Abstract

Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview. Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT. Results: Fewer than half (47.1%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider. Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.

Original language	English
Pages (from-to)	1-16
Number of pages	16
Journal	International Journal of Mental Health Systems
Volume	20
Issue number	1
Early online date	24 Feb 2026
DOIs	https://doi.org/10.1186/s13033-026-00698-w
Publication status	Published (in print/issue) - 30 Mar 2026

Bibliographical note

Data Availability Statement

Access to the cross-national World Mental Health (WMH) data is governed by the organizations funding and responsible for survey data collection in each country. These organizations made data available to the WMH consortium through restricted data sharing agreements that do not allow us to release the data to third parties. The exception is that the U.S. data are available for secondary analysis via the Inter-University Consortium for Political and Social Research (ICPSR), http://www.icpsr.umich.edu/icpsrweb/ICPSR/series/00527.

Funding

The World Mental Health (WMH) Survey Initiative is supported by the United States National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. 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 report are those of the authors and should not be construed to represent the views of the sponsoring organizations, agencies, or governments. The Argentina survey − Estudio Argentino de Epidemiología en Salud Mental (EASM) − was supported by a grant from the Argentinian Ministry of Health (Ministerio de Salud de la Nación) − (Grant Number 2002–17270/13–5). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204–3. The Bulgarian Epidemiological Study of common mental disorders, EPIBUL, is supported by the Ministry of Health and the National Center for Public Health Protection. The second Bulgarian survey, EPIBUL 2, is supported by the Ministry of Health and European Economic Area Grants. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD surveys (Belgium; France; Germany; Italy; Netherlands; Spain) were funded by the European Commission (Contracts QLG5-1999–01042; SANCO 2004123, and EAHC 20081308), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000–158-CE), Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by the National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the PanAmerican Health Organization (PAHO). The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the World Health Organization (WHO) (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care –EZOP Project (PL 0256) was carried out by the Institute of Psychiatry and Neurology, Warsaw in consortium with the Department of Psychiatry, Medical University, Wroclaw, the National Institute of Public Health—National Institute of Hygiene, Warsaw and in partnership with Psykiatrist Institut, Vinderen, Universitet Oslo. The project was funded by the European Economic Area Financial Mechanism and the Norwegian Financial Mechanism. EZOP project was co-financed by the Polish Ministry of Health. The second Polish survey, EZOP – 2, was carried out by the Institute of Psychiatry and Neurology, Warsaw in collaboration with colleagues from the National Institute of Public Health – National Institute of Hygiene, Warsaw and was entirely funded by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and the Portuguese Ministry of Health. The Romania WMH study projects"Policies in Mental Health Area"and"National Study regarding Mental Health and Services Use"were carried out by National School of Public Health & Health Services Management (present National School of Public Health Management & Professional Development, Bucharest), with technical support of Metro Media Transilvania, the National Institute of Statistics, SC Cheyenne Services SRL, and Statistics Netherlands. Funding was provided by the Ministry of Public Health with supplemental support of Eli Lilly Romania SRL. The Psychiatric Enquiry to General Population in Southeast Spain, Murcia, (PEGASUS-Murcia) Project, has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. JRP receives funding support from the National Institute of Mental Health (5R01MH121632-02). DJS is supported by the Medical Research Council of South Africa (MRC). A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

Mental disorders treatment
Adequacy of treatment
Effective treatment coverage
Cross-national
World Mental Health Survey Consortium

Access to Document

10.1186/s13033-026-00698-wLicence: CC BY-NC-ND

13033_2026_Article_698.pdfFinal published version, 1.68 MBLicence: CC BY-NC-ND

Cite this

Kazdin, A. E., Pozuelo, J. R., Harris, M. G., Stein, D. J., Viana, M. C., Hwang, I., Kessler, T. L., Manoukian, S. M., Sampson, N. A., Aguilar-Gaxiola, S., Alonso, J., Andrade, L. H., Ayinde, O. O., Borges, G., Bruffaerts, R., Bunting, B., Cardoso, G., Chardoul, S., Domenech, C., ... Vigo, D. V. (2026). Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey. International Journal of Mental Health Systems, 20(1), 1-16. https://doi.org/10.1186/s13033-026-00698-w

@article{3b6dfde6e3c14540ad7f55843eff6ae9,

title = "Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey",

abstract = "Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview. Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT. Results: Fewer than half (47.1\%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider. Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.",

keywords = "Mental disorders treatment, Adequacy of treatment, Effective treatment coverage, Cross-national, World Mental Health Survey Consortium",

author = "Kazdin, \{Alan E.\} and Pozuelo, \{Julia R.\} and Harris, \{Meredith G.\} and Stein, \{Dan J.\} and Viana, \{Maria Carmen\} and Irving Hwang and Kessler, \{Timothy L.\} and Manoukian, \{Sophie M.\} and Sampson, \{Nancy A.\} and Sergio Aguilar-Gaxiola and Jordi Alonso and Andrade, \{Laura Helena\} and Ayinde, \{Olatunde O.\} and Guilherme Borges and Ronny Bruffaerts and Brendan Bunting and Gra{\c c}a Cardoso and Stephanie Chardoul and Cristina Domenech and Oye Gureje and Karam, \{Elie G.\} and Viviane Kovess-Masfety and Fernando Navarro-Mateu and Daisuke Nishi and Jos{\'e} Posada-Villa and Charlene Rapsey and Roest, \{Annelieke M.\} and Stagnaro, \{Juan Carlos\} and Yolanda Torres and Cristian Vladescu and Jacek Wci{\'o}rka and Bogdan Wojtyniak and Zahari Zarkov and Kessler, \{Ronald C.\} and Vigo, \{Daniel V.\}",

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language = "English",

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Kazdin, AE, Pozuelo, JR, Harris, MG, Stein, DJ, Viana, MC, Hwang, I, Kessler, TL, Manoukian, SM, Sampson, NA, Aguilar-Gaxiola, S, Alonso, J, Andrade, LH, Ayinde, OO, Borges, G, Bruffaerts, R, Bunting, B, Cardoso, G, Chardoul, S, Domenech, C, Gureje, O, Karam, EG, Kovess-Masfety, V, Navarro-Mateu, F, Nishi, D, Posada-Villa, J, Rapsey, C, Roest, AM, Stagnaro, JC, Torres, Y, Vladescu, C, Wciórka, J, Wojtyniak, B, Zarkov, Z, Kessler, RC & Vigo, DV 2026, 'Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey', International Journal of Mental Health Systems, vol. 20, no. 1, pp. 1-16. https://doi.org/10.1186/s13033-026-00698-w

Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey. / Kazdin, Alan E.; Pozuelo, Julia R.; Harris, Meredith G. et al.
In: International Journal of Mental Health Systems, Vol. 20, No. 1, 30.03.2026, p. 1-16.

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

TY - JOUR

T1 - Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey

AU - Kazdin, Alan E.

AU - Pozuelo, Julia R.

AU - Harris, Meredith G.

AU - Stein, Dan J.

AU - Viana, Maria Carmen

AU - Hwang, Irving

AU - Kessler, Timothy L.

AU - Manoukian, Sophie M.

AU - Sampson, Nancy A.

AU - Aguilar-Gaxiola, Sergio

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Ayinde, Olatunde O.

AU - Borges, Guilherme

AU - Bruffaerts, Ronny

AU - Bunting, Brendan

AU - Cardoso, Graça

AU - Chardoul, Stephanie

AU - Domenech, Cristina

AU - Gureje, Oye

AU - Karam, Elie G.

AU - Kovess-Masfety, Viviane

AU - Navarro-Mateu, Fernando

AU - Nishi, Daisuke

AU - Posada-Villa, José

AU - Rapsey, Charlene

AU - Roest, Annelieke M.

AU - Stagnaro, Juan Carlos

AU - Torres, Yolanda

AU - Vladescu, Cristian

AU - Wciórka, Jacek

AU - Wojtyniak, Bogdan

AU - Zarkov, Zahari

AU - Kessler, Ronald C.

AU - Vigo, Daniel V.

PY - 2026/3/30

Y1 - 2026/3/30

N2 - Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview. Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT. Results: Fewer than half (47.1%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider. Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.

AB - Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview. Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT. Results: Fewer than half (47.1%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider. Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.

KW - Mental disorders treatment

KW - Adequacy of treatment

KW - Effective treatment coverage

KW - Cross-national

KW - World Mental Health Survey Consortium

U2 - 10.1186/s13033-026-00698-w

DO - 10.1186/s13033-026-00698-w

M3 - Article

C2 - 41736041

SN - 1752-4458

VL - 20

SP - 1

EP - 16

JO - International Journal of Mental Health Systems

JF - International Journal of Mental Health Systems

IS - 1

ER -

Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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