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Zech JM, Patel TA, Cougle JR. Correlates of treatment-seeking in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Anxiety Disord 2024; 106:102909. [PMID: 39047416 DOI: 10.1016/j.janxdis.2024.102909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population.
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Affiliation(s)
- James M Zech
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, United States.
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2
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Matsuyama S, Otsubo T, Nomoto K, Higa S, Takashio O. Prevalence of Generalized Anxiety Disorder in Japan: A General Population Survey. Neuropsychiatr Dis Treat 2024; 20:1355-1366. [PMID: 38947368 PMCID: PMC11214750 DOI: 10.2147/ndt.s456272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/05/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Generalized anxiety disorder (GAD) is among the most prevalent and highly disabling mental health conditions that negatively impacts patient's quality of life (QOL) and disrupts activities of daily living. However, the recognition of GAD is difficult due to substantial overlap with other mental disorders. The purpose of this study was to estimate the prevalence of GAD, assess QOL of probable GAD patients in Japan, and gain insights on the status of visiting medical institutions as well as their recognition/awareness of the disorder. Patients and Methods We conducted a web-based cross-sectional survey of 20,009 participants using a questionnaire with approximately 30 single/multiple choice or open-ended questions in Japanese. Results Overall prevalence of GAD based on Generalized Anxiety Disorder 7-item (GAD-7) cutoff score of ≥10 and questionnaires developed with reference to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria was 7.6% (n=1530) and 6.0% (n=1197), respectively. The degree of coincidence between GAD diagnosis by DSM-5 criteria and GAD-7 scores was moderate (Cohen's Kappa=0.47, p<0.01). Younger people reported a substantially higher prevalence of GAD compared to older. QOL scores assessed using EuroQol 5 dimensions 5-level and EuroQol Visual Analog Scale were substantially lower in probable GAD patients than those with GAD-7<10. Anxiety/depression and pain/discomfort were the most prevalent issues and depression was the most reported comorbidity for the probable GAD patients. Probable GAD patients "currently visiting medical institutions" for anxiety or other mental issues were 27.6% (422/1530); a majority had seen specialists. Most of the probable GAD patients had never heard of the disease. Conclusion We found higher prevalence of GAD and lower QOL of probable GAD patients in Japan. There is a need for creating awareness about GAD among the general population and developing clinical guidelines on GAD in Japan so that physicians can educate their patients.
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Affiliation(s)
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan
| | - Keisuke Nomoto
- Medical Affairs, Viatris Pharmaceuticals Japan Inc., Tokyo, Japan
| | - Shingo Higa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc., Tokyo, Japan
| | - Osamu Takashio
- Department of Neuropsychiatry, Showa University East Hospital, Tokyo, Japan
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3
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Li G, Su Q. Exploring the role of personal quantification in alleviating generalized anxiety disorder among Chinese PhD students: A cross-sectional study. Medicine (Baltimore) 2024; 103:e38449. [PMID: 38847731 PMCID: PMC11155607 DOI: 10.1097/md.0000000000038449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
Personal quantification plays a crucial role in preserving individual mental health. However, in previous research, its effectiveness in alleviating generalized anxiety disorder (GAD) has not been conclusively established. This study explores the impact of personal quantification on GAD among PhD students. The research data was obtained through questionnaires distributed to 308 PhD students across universities in China. Among these students, 118 anxiety-free participants were excluded, yielding valuable data from 190 students with GADs. We employed Python programming language and SPSS software for the empirical analysis. The results illustrated that personal quantification significantly and negatively impacted GAD (β = -0.148, P = .002), concurrently producing a significantly positive effect on self-efficacy (β = 0.359, P < .001). Further analysis showed that through 5000 sampling iterations and a 95% confidence level, self-efficacy significantly reduced certain symptoms of GAD (β = -0.1183; P = .026; 95% Cl: -0.2222 to -0.0144). Moreover, when the coefficient of self-efficacy was significantly negative, the impact of personal quantification on GAD remained statistically significant (β = -0.1056; P = .033; 95% Cl: -0.2025 to -0.0087). The findings indicated that personal quantification has a significant role in alleviating GAD among PhD students, which is partly mediated through self-efficacy. This study contributes valuable insights to the nonpharmacological alleviation of GAD in Chinese PhD students.
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Affiliation(s)
- Guilong Li
- Business School, Central University of Finance and Economics, Beijing, China
- School of Business Administration, Xinjiang University of Finance & Economics, Urumqi, Xinjiang, China
| | - Qiulan Su
- Business School, Central University of Finance and Economics, Beijing, China
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4
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Basile VT, Newton-John T, Wootton BM. Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder. J Clin Psychol 2024; 80:1286-1305. [PMID: 38384113 DOI: 10.1002/jclp.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental health condition, associated with considerable individual and economic burden. Despite the availability of effective treatments, many individuals do not access support. The current study explores treatment histories, barriers to help-seeking, and cognitive behavioral therapy (CBT) treatment preferences for individuals with clinically significant GAD symptoms. The utility of Health Belief Model (HBM) in predicting help-seeking is also examined. A cross-sectional design with 127 participants (Mage = 29.17; SD = 11.86; 80.3% female) was used. Sixty-two percent of participants reported previously seeking psychological treatment, and approximately 28% received CBT in the first instance. The most influential treatment barriers were a desire to solve the problem on one's own (M = 1.96, SD = 0.96), followed by affordability (M = 1.75, SD = 1.15) and feeling embarrassed or ashamed (M = 1.75, SD = 1.06). The most preferred treatment modes were in-person individual treatment (M = 7.59, SD = 2.86) followed by remote treatment via videoconferencing (M = 4.31, SD = 3.55). Approximately 38% of the variance in intention to seek treatment was associated with the HBM variables, with perceived benefit of treatment being the strongest predictor. Results have the potential to inform mental health service delivery by reducing treatment barriers and aligning public health campaigns with benefits of psychological treatments.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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5
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Nomoto K, Takashio O, Matsuyama S, Higa S, Otsubo T. Diagnosis and Treatment of Generalized Anxiety Disorder in Japan: Psychiatric Specialist Survey. Neuropsychiatr Dis Treat 2024; 20:1001-1010. [PMID: 38764746 PMCID: PMC11102089 DOI: 10.2147/ndt.s456276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/18/2024] [Indexed: 05/21/2024] Open
Abstract
Purpose Generalized anxiety disorder (GAD) is a suboptimally managed chronic recurring psychiatric condition with a lifetime prevalence of 2.6% in Japan. We assessed the current status of GAD management in Japan. Patients and Methods This was an observational, cross-sectional study conducted through an anonymous web-based survey in Japan from December 12-16, 2022. Psychiatrists and psychosomatic medicine physicians who agreed to participate and saw ≥10 outpatients in the previous month were eligible. Survey questionnaire comprised 37 single/multiple choice, numerical entry, or open-ended questions in Japanese. Results Among 509 participants (493 psychiatrists and 16 psychosomatic medicine physicians), 96.9% were aware of GAD. On average, 12.4 outpatients and 1.0 inpatient were diagnosed with GAD per physician per month. Of 433 physicians having patients diagnosed with GAD, 46.9% used operational diagnostic tools; among these, DSM-5 diagnostic criteria were used by 81.5% physicians. The majority (54.7%) of participants did not use a self-administered rating scale; depression scales were used more than anxiety scales. Among these 433 physicians, 96.8% used selective serotonin reuptake inhibitors for GAD management, and 79.2% used it as the first choice; of 431 physicians who prescribed drug therapy, 54.3% gave antidepressant monotherapy as first choice. The most frequent symptom in patients diagnosed with GAD was excessive anxiety/worry (96.5%); depression was the most commonly reported comorbidity (84.3%) as per physicians aware of GAD (N=508). Conclusion This study illustrates that although GAD awareness is high among Japanese psychiatric specialists, GAD is not frequently diagnosed using operational diagnostic approaches. Due to a lack of Japanese guidelines for GAD diagnosis and treatment, diverse international guidelines are followed, with similar treatment paradigms as that of depression. This may not be an optimal approach given cultural/geographical differences. These findings highlight the need for uniform diagnosis and treatment recommendations for GAD management in Japan. Clinical Trial Registration UMIN-CTR: UMIN000049572.
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Affiliation(s)
- Keisuke Nomoto
- Medical Affairs, Viatris Pharmaceuticals Japan Inc., Tokyo, Japan
| | - Osamu Takashio
- Department of Neuropsychiatry, Showa University East Hospital, Tokyo, Japan
| | | | - Shingo Higa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc., Tokyo, Japan
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan
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Kowalczyk M, Kornacka M, Kostrzewa Z, Krejtz I. Differences in anxiety, worry, and perceived stress among naturally cycling women and oral contraceptives users: a cross-sectional study investigating the role of contraceptive types. Arch Womens Ment Health 2024; 27:241-247. [PMID: 38017240 PMCID: PMC10933156 DOI: 10.1007/s00737-023-01405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
The goal of our study was to test whether the types of OC affect the link between anxiety and its main maintenance factors: worry and perceived stress. Women are particularly at risk of being affected by excessive worrying, a core component of generalized anxiety disorder (GAD), and they are twice as likely as men to suffer from GAD. The literature suggests that gonadal hormones and types of oral contraceptives (OC) should be taken into account when exploring anxiety disorders in women, but the precise mechanism of this link remains understudied. We performed an observational cross-sectional study on a sample of 908 women, including 499 women naturally cycling (NC) and 409 taking OC (277 in the anti-androgenic group, 132 in the androgenic group). The participants filled in a battery of online questionnaires. Anxiety positively correlated with worry and perceived stress in the whole sample and in the three groups: androgenic OC, anti-androgenic OC, and NC. There was no significant difference between the groups on all the variables apart from the age of the participants. However, we found that women taking anti-androgenic OC had significantly higher levels of worry than NC women (after controlling for stress and age). The differences in OC types should be taken into account in future studies which might also lead to a better choice of OC based on women's individual needs.
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Affiliation(s)
| | | | | | - Izabela Krejtz
- SWPS University, Institute of Psychology, Warsaw, Poland
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7
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Tan RHS, Koh YS, Vaingankar JA, Abdin E, Sambasivam R, Chong SA, Subramaniam M. Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 2024; 59:375-383. [PMID: 36786835 DOI: 10.1007/s00127-023-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Although the trajectory of mental disorders can be improved with timely treatment, many people defer treatment-seeking. This study aimed to examine the prevalence and correlates of treatment delays for mental disorders in Singapore, as well as perceived effectiveness of treatment received. METHODS A total of 6126 respondents, aged 18 and above, participated in the Singapore Mental Health Study 2016-a cross-sectional, nationwide study conducted in Singapore from 2016 to 2018. Lifetime treatment contact for mood, anxiety, and alcohol use disorders (AUD) was assessed using the World Mental Health-Composite International Diagnostic Interview (Version 3.0). Multivariable logistic regression was conducted to examine correlates of delayed treatment. RESULTS A total of 137 participants had made lifetime treatment contact for a mental disorder. The proportion of respondents who received delayed treatment (i.e., at least one year after onset of disorder) was 60.8% for any disorder, 59.5% for mood disorders, 56.3% for anxiety disorders, and 92.7% for AUD. The median delay was 5 years for mood disorders, one year for anxiety disorders, and 4 years for AUD. Treatment delay was significantly associated with older age, higher educational qualification, lifetime AUD, and earlier age of onset of disorder. 58.4% of respondents with lifetime treatment contact had received treatment that they considered effective. CONCLUSION The high prevalence and long durations of treatment delay underscore the need to encourage help-seeking for mental disorders, especially since treatment is generally perceived to be helpful. Our findings also highlight several population groups more susceptible to receiving delayed treatment.
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Affiliation(s)
- Rachel Hsiao Shen Tan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Yen Sin Koh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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8
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Stein DJ. Evidence-Based Pharmacotherapy of Anxiety Symptoms in Patients with Major Depressive Disorder: Focus on Agomelatine. Neurol Ther 2023; 12:13-19. [PMID: 37115460 PMCID: PMC10147848 DOI: 10.1007/s40120-023-00470-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Patients with depression require thorough clinical assessment, which should include symptom profile, severity and staging, personality factors, antecedent and concurrent psychiatric comorbidity, physical comorbidity, neurocognitive function, exposure to stressors in early life (e.g. trauma) or recently (e.g. bereavement), and protective factors. The presence of anxiety symptoms in a depressed patient is associated with more severe depression, increased suicidality and worse outcomes compared with non-anxious depression. A network meta-analysis of antidepressant treatments found that agomelatine, citalopram, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were all significantly more effective than other antidepressants for the treatment of depression, and that agomelatine, citalopram, escitalopram, fluoxetine, sertraline and vortioxetine were better tolerated than other antidepressants. Agomelatine has been shown to have two major effects-relieving depressive symptoms, and supporting symptomatic and functional recovery-and these benefits have been demonstrated in patients with depression as well as in patients with generalised anxiety disorder, including those with more severe symptoms. Agomelatine has also been shown to be efficacious and well tolerated in patients with depression plus concomitant anxiety symptoms. A pooled analysis of data from six agomelatine studies of depression (three placebo-controlled and three with active comparators-fluoxetine, sertraline and venlafaxine) found that agomelatine was significantly more effective than placebo at relieving the anxiety subscore on the Hamilton Depression Rating Scale, and that the difference between agomelatine and placebo was even more marked in the subgroup of patients with severe anxiety symptoms at baseline. Irrespective of the pharmacotherapy used in patients with depression, the likelihoods of response and remission are increased when pharmacotherapy is combined with psychotherapy, with this approach being more effective than either pharmacotherapy or psychotherapy alone. Persistence with treatment is important, and clinicians should therefore encourage patients to keep trying to obtain relief.
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Affiliation(s)
- Dan J Stein
- University of Cape Town Department of Psychiatry and Neuroscience Institute, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7925, South Africa.
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Li M, Liu X, Ye X, Zhuang L. Efficacy of acupuncture for generalized anxiety disorder: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30076. [PMID: 36626458 PMCID: PMC9750622 DOI: 10.1097/md.0000000000030076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) tightly traps modern people. Its incidence shows an increased peak during the 2019 novel coronavirus (COVID-19) epidemic. Acupuncture is regarded as an effective way to relieve anxiety symptoms. However, there are still controversies. This study aimed to systematically evaluate the clinical efficacy of acupuncture in patients with GAD. METHODS Four English and 3 Chinese databases were searched from their inception to January 2022. Only randomized controlled trials (RCTs) in which acupuncture was the main intervention were included. The literature was independently screened and extracted by two investigators. The Cochrane Bias Risk Assessment Tool was used for quality evaluation. Analyses were conducted by RevMan 5.3.0 and STATA 15.0 software. The primary outcome was the Hamilton Anxiety Scale (HAMA). The secondary indicators were the total effective rate, the Self-Rating Anxiety Scale (SAS), and the Treatment Emergent Symptom Scale (TESS). RESULTS Twenty-seven studies were included with a total of 1782 participants. The risk of performance bias or reporting bias for most of the included trials was unclear. Combined results showed the acupuncture group had better outcomes in the HAMA score [MD = -0.78, 95%CI (-1.09, -0.46)], the total effective rate [RR = 1.14, 95%CI (1.09, 1.19)], the SAS score [MD = -2.55, 95%CI (-3.31, -1.80)] compared with the control group. Regarding the number of adverse events, the acupuncture group was safer than the control group and scored less grade in the TESS score [MD = -1.54, 95%CI (-1.92, -1.17)]. CONCLUSIONS Acupuncture can effectively relieve the anxiety symptoms of generalized anxiety disorder patients with fewer side effects, but randomized controlled trials with large sample size and high quality are also required to support the result.
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Affiliation(s)
- Meichen Li
- Acupuncture and rehabilitation clinical collage of Guangzhou University of Chinese Medicine
| | - Xin Liu
- Acupuncture and rehabilitation clinical collage of Guangzhou University of Chinese Medicine
| | - Xinyi Ye
- Dongguan Traditional Chinese Medicine Hospital
| | - Lixing Zhuang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- *Correspondence: Lixing Zhuang, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (e-mail: )
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Astudillo-García CI, Austria-Corrales F, Rivera-Rivera L, Reynales-Shigematsu LM, Gómez-García JA, Séris-Martinez M, Jiménez-Tapia A, Robles R, Morales-Chainé S, López-Montoya A, Cuevas-Renaud C, Toledano-Toledano F. Measurement invariance of the GAD-5 Generalized Anxiety Disorder Scale in a Mexican general population sample. Front Psychiatry 2022; 13:973134. [PMID: 36299536 PMCID: PMC9590252 DOI: 10.3389/fpsyt.2022.973134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionnaire during the COVID-19 pandemic in Mexico. The sex variable was classified as male or female; age was categorized as minors, youth, young adults, adults, and older adults; and educational level was divided into basic, upper secondary, higher, and graduate education. To test for configural invariance, confirmatory factor models were constructed. For metric invariance, equality restrictions were established for the factor loadings between the construct and its items; for scalar invariance, equality restrictions were established between the intercepts; strict variance implied the additional restriction of the residuals. Statistical analysis was performed in R software with the lavaan package. The results show that with respect to sex, age, and educational level, configural and metric measurement invariance was confirmed (ΔCFI < 0.002; ΔRMSEA < 0.015). However, with respect to scalar and strict invariance, the results showed significant differences regarding the fit model (ΔCFI > 0.002; ΔRMSEA > 0.015). We conclude that the GAD-5 presents configural and metric invariance for sex, age, and educational level, and scalar invariance for sex and age groups. However, the scale does not demonstrate strict invariance. We discuss the implications and suggest that this result could be related to the evaluation of sociodemographic variables.
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Affiliation(s)
| | | | - Leonor Rivera-Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, México
| | | | - José Alberto Gómez-García
- Secretariado Técnico del Consejo Nacional de Salud Mental (STCONSAME), Secretaría de Salud, Ciudad de México, México
| | - Marina Séris-Martinez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, México
| | - Alberto Jiménez-Tapia
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Ciudad de México, México
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Ciudad de México, México
| | - Silvia Morales-Chainé
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Corina Cuevas-Renaud
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico
- Unidad de Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Ciudad de México, México
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11
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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 Y, 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 J, 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. 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 2022; 21:272-286. [PMID: 35524618 PMCID: PMC9077614 DOI: 10.1002/wps.20971] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
| | | | | | - Ali Al‐Hamzawi
- College of MedicineAl‐Qadisiya University, Diwaniya GovernorateIraq
| | - Jordi Alonso
- Health Services Research UnitIMIM‐Hospital del Mar Medical Research InstituteBarcelonaSpain
| | - Yasmin A. Altwaijri
- Epidemiology SectionKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiátrica ‐ LIM 23Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Guilherme Borges
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum ‐ Katholieke Universiteit LeuvenLeuvenBelgium
| | | | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Wai Tat Chiu
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Alfredo Cía
- Anxiety Disorders Research CenterBuenos AiresArgentina
| | - Marius Ciutan
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | | | - Peter de Jonge
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Silvia Florescu
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Oye Gureje
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAMUniversitat de BarcelonaBarcelonaSpain
| | - Meredith G. Harris
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning HospitalShenzhenChina
| | - Aimee N. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon
| | - Elie G. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Georges Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Andrzej Kiejna
- Psychology Research Unit for Public HealthWSB UniversityTorunPoland
| | - Viviane Kovess‐Masfety
- Laboratoire de Psychopathologie et Processus de Santé EA 4057Université de ParisParisFrance
| | - Sing Lee
- Department of PsychiatryChinese University of Hong KongTai PoHong Kong
| | | | - John J. McGrath
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia,National Centre for Register‐based ResearchAarhus UniversityAarhusDenmark
| | - Maria Elena Medina‐Mora
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | | | - Fernando Navarro‐Mateu
- Unidad de Docencia, Investigación y Formación en Salud MentalUniversidad de MurciaMurciaSpain
| | - Andrew A. Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Akin Ojagbemi
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | | | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca UniversityFaculty of Social SciencesBogotaColombia
| | | | - Charlene Rapsey
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Kate M. Scott
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud MentalUniversidad de Buenos AiresBuenos AiresArgentina
| | - Dan J. Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental DisordersUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Hisateru Tachimori
- National Institute of Mental HealthNational Center for Neurology and PsychiatryKodairaTokyoJapan
| | - Margreet ten Have
- Trimbos‐InstituutNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES UniversityMedellinColombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito SantoVitoriaBrazil
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada,Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
| | - David R. Williams
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population HealthNational Institute of Public Health ‐ National Research InstituteWarsawPoland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Zahari Zarkov
- Department of Mental HealthNational Center of Public Health and AnalysesSofiaBulgaria
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