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'Neill & 8 others Scott, 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.
LanguageEnglish
JournalJAMA Psychiatry
Publication statusAccepted/In press - 31 Jan 2020

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Major Depressive Disorder
Health Surveys
Mental Health
Therapeutics
Global Health

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Harris, Kazdin, chiu, Sampson, Aguilar-Gaxiola, Al-Hamzawi, ... Kessler (Accepted/In press). Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys. JAMA Psychiatry.
Harris ; Kazdin ; chiu ; Sampson ; Aguilar-Gaxiola ; Al-Hamzawi ; Alonso ; Altwaijri ; Andrade ; Cardoso ; Cia ; Florescu ; Gureje ; Hu ; Karam ; Karam ; Mneimneh ; Navarro-Mateu ; Oladeji, ; O'Neill, Siobhan ; Scott ; Slade ; Torres ; Vigo ; Wojtyniak ; Zarkov ; Ziv ; Kessler. / Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys. In: JAMA Psychiatry. 2020.
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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.",
author = "Harris and Kazdin and chiu and Sampson and Aguilar-Gaxiola and Al-Hamzawi and Alonso and Altwaijri and Andrade and Cardoso and Cia and Florescu and Gureje and Hu and Karam and Karam and Mneimneh and Navarro-Mateu and Oladeji and Siobhan O'Neill and Scott and Slade and Torres and Vigo and Wojtyniak and Zarkov and Ziv and Kessler",
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Harris, Kazdin, chiu, Sampson, Aguilar-Gaxiola, Al-Hamzawi, Alonso, Altwaijri, Andrade, Cardoso, Cia, Florescu, Gureje, Hu, Karam, Karam, Mneimneh, Navarro-Mateu, Oladeji, , O'Neill, S, Scott, Slade, Torres, Vigo, Wojtyniak, Zarkov, Ziv & Kessler 2020, 'Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys', JAMA Psychiatry.

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, ; O'Neill, Siobhan; Scott; Slade; Torres; Vigo; Wojtyniak; Zarkov; Ziv; Kessler.

In: JAMA Psychiatry, 31.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perceived helpfulness of treatment for major depressive disorder: findings from the WHO World Mental Health Surveys

AU - Harris,

AU - Kazdin,

AU - chiu,

AU - Sampson,

AU - Aguilar-Gaxiola,

AU - Al-Hamzawi,

AU - Alonso,

AU - Altwaijri,

AU - Andrade,

AU - Cardoso,

AU - Cia,

AU - Florescu,

AU - Gureje,

AU - Hu,

AU - Karam,

AU - Karam,

AU - Mneimneh,

AU - Navarro-Mateu,

AU - Oladeji,

AU - O'Neill, Siobhan

AU - Scott,

AU - Slade,

AU - Torres,

AU - Vigo,

AU - Wojtyniak,

AU - Zarkov,

AU - Ziv,

AU - Kessler,

PY - 2020/1/31

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N2 - 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.

AB - 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.

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