Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys

Harris, Kazdin, chiu, Sampson, Aguilar-Gaxiola, Al-Hamzawi, Alonso, Altwaijri, Andrade, Cardoso, Cia, Florescu, Gureje, Hu, Karam, Karam, Mneimneh, Navarro-Mateu, Oladeji, Siobhan O'NeillScott, Slade, Torres, Vigo, Wojtyniak, Zarkov, Ziv, Kessler

Research output: Contribution to journalArticle

Abstract

Importance: Perceived helpfulness of treatment is an important patient-centered outcome that is a joint function of (i) whether treatment providers are perceived as helpful and (ii) whether patients persist in help-seeking after previous unhelpful treatments.
Objective: To examine the prevalence and predictors of the two main components of perceived helpfulness of treatment in a representative sample of individuals with a history of depression.
Design: The World Health Organization World Mental Health Surveys, a coordinated series of community epidemiological surveys of non-institutionalized adults.
Setting: Seventeen surveys in 16 countries (8 surveys in high-income and 9 in low/middle-income countries).
Participants: 2,726 people with a lifetime history of treated DSM-IV major depressive disorder (MDD).
Exposures: Socio-economic characteristics, lifetime comorbid conditions (anxiety and substance disorders), treatment type, treatment timing, and country income level.
Main Outcomes and Measures: (i) Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; (ii) persistence in help-seeking after between 1 and 4 unhelpful treatments; and (iii) ever obtaining helpful treatment regardless of number of professionals seen.
Results: Cumulative probability of helpful treatment after seeing up to 5 professionals was 92.9%, but only 39.4% of patients persisted this long (i.e., beyond 4 unhelpful treatments), resulting in 68.2% of patients ever receiving treatment they perceived as helpful. Probability of perceiving treatment as helpful increased with 4 predictors: older age at initiating treatment, higher education, shorter treatment delay, and receiving medication from a mental health specialist. Decomposition showed that the first 2 of these 4 variables predicted only conditional probability of an individual treatment provider being helpful, whereas the latter 2 variables predicted only persistence. A time trend was found for higher probability of an individual treatment provider being helpful in recent years, but a counteracting trend existed for persistence being lower in recent years, resulting in a non-significant association between historical time and patient-level probability of receiving helpful treatment.
Conclusions and Relevance: The probability that MDD patients obtain treatment they consider helpful might increase, perhaps dramatically so, if they persisted in help-seeking after unhelpful treatment with up to 4 prior professionals.
Original languageEnglish
JournalJAMA Psychiatry
Publication statusAccepted/In press - 31 Jan 2020

Fingerprint Dive into the research topics of 'Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys'. Together they form a unique fingerprint.

  • Research Output

    A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys

    Roest, A., de Vries, Y. A., Lim, C., Wittchen, H-U., Stein, D., Adamowski, T., Al-Hamzawi, A., Bromet, E., Viana, M. C., di Girolamo, G., Demyttenaere, K., Florescu, S., Gureje, O., Haro, J. M., Hu, C., Karam, E., Caldas‐de‐Almeida, J. M., Kawakami, N., Lepine, J. P., Levinson, D. & 10 others, Medina Mora, M. E., Navarro-Mateau, F., O'Neill, S., Piazza, M., Posada‐Villa, J. A., Slade, T., Torres, Y., Kessler, R., Scott, K. & de Jonge, P., 4 Jun 2019, In : Depression and Anxiety. 36, 6, p. 499-510 12 p.

    Research output: Contribution to journalArticle

    Open Access
    File
  • 3 Citations (Scopus)
    64 Downloads (Pure)

    Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys

    Rosellini, AJ., Liu, H., Petukhova, MV., Sampson, NA., Aguilar-Gaxiola, S., Alonso, J., Borges, G., Bruffaerts, R., Bromet, E. J., de Girolamo, G., de Jonge, P., Fayyad, J., Florescu, S., Gureje, O., Haro, J. M., Hinkov, H., Karam, EG., Kawakami, N., Koenen, KC., Lee, S. & 14 others, Lépine, J-P., Levinson, D., Navarro-Mateu, F., Oladeji, BD., O'Neill, S., Pennell, BE., Piazza, M., Posada-Villa, J., Scott, KM., Stein, DJ., Torres, Y., Viana, MC., Zaslavsky, AM. & Kessler, RC., Feb 2018, In : Psychological Medicine. 48, 3, p. 437-450

    Research output: Contribution to journalArticle

    Open Access
    File
  • 7 Citations (Scopus)
    14 Downloads (Pure)

    Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys

    Liu, H., Petukhova, M., Sampson, N., Aguilar-Gaxiola, S., Alonso, J., Andrade, L. H., Bromet, E., de Girolamo, G., Haro, J. M., Hinkov, H., Kawakami, N., Koenen, K., Kovess-Masfety, V., Lee, S., Medina-Mora, M-E., Navarro-Mateu, F., O'Neil, S., Piazza, M., Posada-Villa, J., Scott, K. & 7 others, Shahly, V., Stein, D., ten-Have, M., Torres, Y., Gureje, O., Zaslavsky, A. & Kessler, R., 4 Jan 2017, In : JAMA Psychiatry. 74, 3, p. 270-281

    Research output: Contribution to journalArticle

    Open Access
  • 77 Citations (Scopus)

    Cite this

    Harris, Kazdin, chiu, Sampson, Aguilar-Gaxiola, Al-Hamzawi, Alonso, Altwaijri, Andrade, Cardoso, Cia, Florescu, Gureje, Hu, Karam, Karam, Mneimneh, Navarro-Mateu, Oladeji, ... Kessler (Accepted/In press). Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys. JAMA Psychiatry.