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Harris MG, Kazdin AE, Munthali RJ, Vigo DV, Stein DJ, Viana MC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bunting B, Chardoul S, Gureje O, Hu C, Hwang I, Karam EG, Navarro-Mateu F, Nishi D, Orozco R, Sampson NA, Scott KM, Vladescu C, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report. Int J Ment Health Syst 2024; 18:11. [PMID: 38429785 PMCID: PMC10908125 DOI: 10.1186/s13033-024-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.
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Affiliation(s)
- Meredith G Harris
- School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
| | - Alan E Kazdin
- Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA
| | - Richard J Munthali
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, ZA, 7925, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Espirito Santo - ES, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo - ES, 2905-600, Brazil
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, CA, 95817, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, P.O.Box 88, Al-Diwaniyah, Al-Qadisiyah, Iraq
| | - Jordi Alonso
- IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
| | - Laura Helena Andrade
- University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil
| | - Brendan Bunting
- School of Psychology, Ulster University, College Avenue, Londonderry, BT48 7JL, UK
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB, 5116, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon
- Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58. -El Palmar, Murcia, 30120, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain
- Centro de Investigación Biomédica en Red en Epidemíologia y Salud Pública, El Palmar, Murcia, 30120, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ricardo Orozco
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, Ciudad de México, 14370, Mexico
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand
| | - Cristian Vladescu
- National Institute for Health Services Management, 31 Vaselor Str, Bucharest, 21253, Romania
- University Titu Maiorescu, Dâmbovnicului no. 22, Bucharest, Romania
| | - Bogdan Wojtyniak
- National Institute of Public Health, National Research Institute, 24 Chocimska St, Warsaw, 00-791, Poland
| | - Miguel Xavier
- Faculdade Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, Lisbon, 1169-056, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd, Sofia, 1431, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
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2
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McGrath JJ, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Bromet EJ, Bruffaerts R, de Almeida JMC, Chardoul S, Chiu WT, Degenhardt L, Demler OV, Ferry F, Gureje O, Haro JM, Karam EG, Karam G, Khaled SM, Kovess-Masfety V, Magno M, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Plana-Ripoll O, Posada-Villa J, Rapsey C, Sampson NA, Stagnaro JC, Stein DJ, Ten Have M, Torres Y, Vladescu C, Woodruff PW, Zarkov Z, Kessler RC. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. Lancet Psychiatry 2023; 10:668-681. [PMID: 37531964 PMCID: PMC10529120 DOI: 10.1016/s2215-0366(23)00193-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. METHODS In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. FINDINGS We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. INTERPRETATION By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. FUNDING None.
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Affiliation(s)
- John J McGrath
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia; National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Ali Al-Hamzawi
- College of Medicine, University of Al-Qadisiya, Al Diwaniya, Iraq
| | - Jordi Alonso
- Health Services Research Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura H Andrade
- Section of Psychiatric Epidemiology, Institute of Psychiatry, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olga V Demler
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Computer Science, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Finola Ferry
- School of Psychology, Ulster University, Belfast, UK
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Centre for Biomedical Research on Mental Health, Madrid, Spain; Departament de Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar
| | | | - Marta Magno
- Unit of Epidemiological and Evaluation Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain; Murcia Biomedical Research Institute, Murcia, Spain; Centro de Investigación Biomédica en Red Epidemiology and Public Health-Murcia, Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, Instituto de Ciencias de la Salud, Medellín, Colombia
| | - Cristian Vladescu
- National Institute for Health Services Management, Bucharest, Romania
| | - Peter W Woodruff
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
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3
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Kazdin AE, Wu CS, Hwang I, Puac-Polanco V, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Benjet C, Caldas-de-Almeida JM, de Girolamo G, de Jonge P, Florescu S, Gureje O, Haro JM, Harris MG, Karam EG, Karam G, Kovess-Masfety V, Lee S, McGrath JJ, Navarro-Mateu F, Nishi D, Oladeji BD, Posada-Villa J, Stein DJ, Üstün TB, Vigo DV, Zarkov Z, Zaslavsky AM, Kessler RC. Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report. Psychol Med 2023; 53:1583-1591. [PMID: 37010212 PMCID: PMC10071359 DOI: 10.1017/s0033291721003160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. METHODS Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. RESULTS 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2-4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. CONCLUSION ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
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Affiliation(s)
- Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - José-Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, The Netherlands
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J. McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia QLD 4065, Australia
- National Centre for Register-based Research, Aarhus University, Aarhus V 8000 Denmark
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Dan J. Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town
- Groote Schuur Hospital, Cape Town, Republic of South Africa
| | | | - Daniel V. Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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4
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Bruffaerts R, Harris MG, Kazdin AE, Vigo DV, Sampson NA, Chiu WT, Al-Hamzawi A, Alonso J, Altwaijri YA, Andrade L, Benjet C, de Girolamo G, Florescu S, Haro JM, Hu CY, Karam A, Karam EG, Kovess-Masfety V, Lee S, McGrath JJ, Navarro-Mateu F, Nishi D, O'Neill S, Posada-Villa J, Scott KM, Have MT, Torres Y, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2079-2095. [PMID: 35262761 PMCID: PMC9458773 DOI: 10.1007/s00127-022-02249-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample. METHODS The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD. RESULTS In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders. CONCLUSIONS The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.
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Affiliation(s)
- Ronny Bruffaerts
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Queensland, Herston, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Wacol, Australia
| | - Alan E Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiyah University, Diwaniyah Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin A Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura Andrade
- Núcleo de Epidemiologia Psiquiátrica-LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chi-Yi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, China
| | - Aimee Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Wacol, Australia
- Queensland Brain Institute, University of Queensland, Queensland, St Lucia, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Región de Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Bogdan Wojtyniak
- Department of Population Health Monitoring and Analysis, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
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5
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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: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Roth C, Wensing M, Kuzman MR, Bjedov S, Medved S, Istvanovic A, Grbic DS, Simetin IP, Tomcuk A, Dedovic J, Djurisic T, Nica RI, Rotaru T, Novotni A, Bajraktarov S, Milutinovic M, Nakov V, Zarkov Z, Dinolova R, Walters BH, Shields-Zeeman L, Petrea I. Experiences of healthcare staff providing community-based mental healthcare as a multidisciplinary community mental health team in Central and Eastern Europe findings from the RECOVER-E project: an observational intervention study. BMC Psychiatry 2021; 21:525. [PMID: 34689733 PMCID: PMC8543797 DOI: 10.1186/s12888-021-03542-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were. METHOD An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models. RESULT The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles. CONCLUSION The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention. TRIAL REGISTRATION Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 ).
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Affiliation(s)
- Catharina Roth
- grid.5253.10000 0001 0328 4908Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
| | - Martina Rojnic Kuzman
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia ,grid.4808.40000 0001 0657 4636Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sarah Bjedov
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Sara Medved
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Ana Istvanovic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Danijela Stimac Grbic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Ivana Pavic Simetin
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Aleksandar Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Tatijana Djurisic
- Public Health Institute of Montenegro, Dzona Dzeksona bb, 81000 Podgorica, Montenegro
| | - Raluca Ileana Nica
- Institute Liga Romana pentru Sanatate Mintala, Sos. Mihai Bravu 90-96, Bucuresti-Sector 2, Romania
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Strada 9 Mai 5, 725500 Siret, Romania
| | - Antoni Novotni
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Stojan Bajraktarov
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Milos Milutinovic
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Vladimir Nakov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Zahari Zarkov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Roumyana Dinolova
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Bethany Hipple Walters
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Laura Shields-Zeeman
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Ionela Petrea
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands ,Present Address: INSIGHT International Institute for Mental Health and Integrated Health Systems, Cornelis Anthoniszstraat 23-1, 1071VP Amsterdam, Netherlands
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7
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Stein DJ, Kazdin AE, Ruscio AM, Chiu WT, Sampson NA, Ziobrowski HN, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Bruffaerts R, Bunting B, de Girolamo G, de Jonge P, Degenhardt L, Gureje O, Haro JM, Harris MG, Karam A, Karam EG, Kovess-Masfety V, Lee S, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Posada-Villa J, Scott KM, Viana MC, Vigo DV, Xavier M, Zarkov Z, Kessler RC. Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry 2021; 21:392. [PMID: 34372811 PMCID: PMC8351147 DOI: 10.1186/s12888-021-03363-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. METHODS Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. RESULTS The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. CONCLUSIONS The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.
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Affiliation(s)
- Dan J. Stein
- grid.7836.a0000 0004 1937 1151Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alan E. Kazdin
- grid.47100.320000000419368710Department of Psychology, Yale University, New Haven, CT USA
| | - Ayelet Meron Ruscio
- grid.25879.310000 0004 1936 8972Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
| | - Wai Tat Chiu
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Nancy A. Sampson
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Hannah N. Ziobrowski
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Sergio Aguilar-Gaxiola
- grid.416958.70000 0004 0413 7653Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
| | - Jordi Alonso
- grid.20522.370000 0004 1767 9005Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5612.00000 0001 2172 2676Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin Altwaijri
- grid.415310.20000 0001 2191 4301Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ronny Bruffaerts
- grid.5596.f0000 0001 0668 7884Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- grid.12641.300000000105519715School of Psychology, Ulster University, Londonderry, UK
| | - Giovanni de Girolamo
- grid.419422.8IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Peter de Jonge
- grid.4830.f0000 0004 0407 1981Department of Developmental Psychology, University of Groningen, Groningen, Netherlands ,grid.4494.d0000 0000 9558 4598Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - Louisa Degenhardt
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Oye Gureje
- grid.412438.80000 0004 1764 5403Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G. Harris
- grid.1003.20000 0000 9320 7537School of Public Health, The University of Queensland, Herston, QLD 4006 Australia ,grid.417162.70000 0004 0606 3563Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4072 Australia
| | - Aimee Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Elie G. Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon ,grid.416659.90000 0004 1773 3761Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon ,grid.33070.370000 0001 2288 0342Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- grid.508487.60000 0004 7885 7602Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- grid.10784.3a0000 0004 1937 0482Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Maria Elena Medina-Mora
- grid.419154.c0000 0004 1776 9908National Institute of Psychiatry-Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jacek Moskalewicz
- grid.418955.40000 0001 2237 2890Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Fernando Navarro-Mateu
- grid.419058.10000 0000 8745 438XUDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Murcia, Spain
| | - Daisuke Nishi
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.419280.60000 0004 1763 8916National Center of Neurology and Psychiatry, Tokyo, Japan
| | - José Posada-Villa
- grid.441728.c0000 0004 1779 6631Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M. Scott
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Maria Carmen Viana
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Daniel V. Vigo
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Miguel Xavier
- grid.10772.330000000121511713Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- grid.416574.5Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
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8
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de Vries YA, Harris MG, Vigo D, Chiu WT, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Benjet C, Bruffaerts R, Bunting B, de Almeida JMC, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Moskalewicz J, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Scott K, Torres Y, Zarkov Z, Nierenberg A, Kessler RC, de Jonge P. Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys. J Affect Disord 2021; 288:199-209. [PMID: 33940429 PMCID: PMC8154701 DOI: 10.1016/j.jad.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Región de Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia (Cundinamarca University, calle 28 # 5B 02, Bogotá, 11001000 (zip), Colombia)
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Andrew Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
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9
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Harris MG, Kazdin AE, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Cardoso G, Cía A, Florescu S, Gureje O, Hu C, Karam EG, Karam G, Mneimneh Z, Navarro-Mateu F, Oladeji BD, O’Neill S, Scott K, Slade T, Torres Y, Vigo D, Wojtyniak B, Zarkov Z, Ziv Y, Kessler RC. Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder. JAMA Psychiatry 2020; 77:830-841. [PMID: 32432716 PMCID: PMC7240636 DOI: 10.1001/jamapsychiatry.2020.1107] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
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Affiliation(s)
- Meredith G. Harris
- The University of Queensland School of Public Health, Herston, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Ali Al-Hamzawi
- Al-Qadisiya University College of Medicine, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- IMIM–Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain,Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain,CIBER en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM 23), Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Alfredo Cía
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | | | - Siobhan O’Neill
- Ulster University School of Psychology, Londonderry, United Kingdom
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bogdan Wojtyniak
- National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Directorate of Mental Health and Prevention of Addictions, Sofia, Bulgaria
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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10
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Beezhold J, Stoyanov D, Nakov V, Killaspy H, Gaebel W, Zarkov Z, Hinkov H, Galderisi S. Transitions in Mental Health Care: the European Psychiatric Association contribution to reform in Bulgaria. Eur Psychiatry 2020; 63:1-13. [PMID: 32366337 PMCID: PMC7355170 DOI: 10.1192/j.eurpsy.2020.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/16/2020] [Accepted: 02/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The Bulgarian Ministry of Health invited the European Psychiatric Association (EPA) to evaluate Bulgarian mental health care service provision in 2018. Bulgarian mental health services face very significant challenges including a legacy of historic underfunding, internal conflicts, poor planning, and the emigration of very high numbers of younger skilled staff that had followed accession to the European Union. There were significant disputes between stakeholders regarding the way forward and had been at least two unsuccessful previous external agency interventions that had attempted to find solutions. Method: This EPA position paper describes in detail the EPA mission to Bulgaria including methodology, findings, recommendations, and finally the positive actions and changes that are now underway as a result of the EPA report and intervention aimed at contributing towards improving Bulgarian mental health services. Results: After meetings with multiple stakeholders in the Bulgarian mental health system and analysis of data on service delivery, workforce, funding and configuration the EPA Panel agreed a list of twenty recommendations for change. Conclusions: The EPA mission, with the collaboration of multiple stakeholders in Bulgaria, was successful in stimulating high level government action to improve mental health services. Despite longstanding differences, it was possible to involve the stakeholders in constructive dialogue. The importance of “speaking with one voice” was a key lesson learned.
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Affiliation(s)
- Julian Beezhold
- Dr Julian Beezhold FRCPsych, Honorary Senior Lecturer Norwich Medical School UEA, Consultant in Liaison Psychiatry, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, United Kingdom.
| | - Drozdstoy Stoyanov
- Prof Drozdstoy Stoyanov, Acting Head, Department of Psychiatry and Medical Psychology, Head, Neuropsychiatry and Brain Imaging Group, Medical University of Plovdiv, Bulgaria.
| | - Vladimir Nakov
- Dr Vladimir Nakov, MD, PhD, Assistant Professor, Department Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov str, 9 floor, office 20, 1431 Sofia, Bulgaria.
| | - Helen Killaspy
- Helen Killaspy MBBS, FRCPsych, PhD, Professor of Rehabilitation Psychiatry, UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom.
| | - Wolfgang Gaebel
- Prof. Dr. Wolfgang Gaebel, WHO Collaborating Centre, LVR- Klinkum Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany.
| | - Zahari Zarkov
- Zahari Zarkov MD,PhD, Assistant Professor, National Center of Public Health and Analyses (NCPHA), Head of Department Mental Health, 15, Acad. I., Geshov st., 1431 Sofia,
| | - Hristo Hinkov
- Assoc. Prof. Hristo Hinkov, MD, PhD, Director, National Centre of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd. Sofia 1431, Bulgaria.
| | - Silvana Galderisi
- Prof. Silvana Galderisi Professor of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
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11
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Degenhardt L, Bharat C, Glantz MD, Sampson NA, Scott K, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bromet EJ, Bruffaerts R, Bunting B, de Girolamo G, Gureje O, Haro JM, Harris MG, He Y, de Jonge P, Karam EG, Karam GE, Kiejna A, Lee S, Lepine JP, Levinson D, Makanjuola V, Medina-Mora ME, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Stein DJ, Tachimori H, Torres Y, Zarkov Z, Chatterji S, Kessler RC. The epidemiology of drug use disorders cross-nationally: Findings from the WHO's World Mental Health Surveys. Int J Drug Policy 2019; 71:103-112. [PMID: 31255918 DOI: 10.1016/j.drugpo.2019.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Illicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative involves a standardised method for assessing mental and substance use disorders via structured diagnostic interviews in representative community samples of adults. We conducted cross-national comparisons of the prevalence and correlates of drug use disorders (DUDs) in countries of varied economic, social and cultural nature. METHODS AND FINDINGS DSM-IV DUDs were assessed in 27 WMH surveys in 25 countries. Across surveys, the prevalence of lifetime DUD was 3.5%, 0.7% in the past year. Lifetime DUD prevalence increased with country income: 0.9% in low/lower-middle income countries, 2.5% in upper-middle income countries, 4.8% in high-income countries. Significant differences in 12-month prevalence of DUDs were found across country in income groups in the entire cohort, but not when limited to users. DUDs were more common among men than women and younger than older respondents. Among those with a DUD and at least one other mental disorder, onset of the DUD was usually preceded by the 'other' mental disorder. CONCLUSIONS Substantial cross-national differences in DUD prevalence were found, reflecting myriad social, environmental, legal and other influences. Nonetheless, patterns of course and correlates of DUDs were strikingly consistent. These findings provide foundational data on country-level comparisons of DUDs.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia.
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia
| | - Meyer D Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, MD, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Carmen C W Lim
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia; Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | | | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura H Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G Harris
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia; School of Public Health, The University of Queensland, QLD, Australia
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges E Karam
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Andrzej Kiejna
- Wroclaw Medical University, Wroclaw, Poland; University of Lower Silesia, Wroclaw, Poland
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France; Universités Paris Descartes-Paris Diderot, Paris, France; Institut National de la Sante et de la Recherche Medicale (INSERM) UMR-S 1144, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Victor Makanjuola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Somnath Chatterji
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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12
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Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Chiu W, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kawakami N, Lee S, Lund C, Kovess-Masfety V, Levinson D, Navarro-Mateu F, Pennell BE, Sampson N, Scott K, Tachimori H, ten Have M, Viana MC, Williams DR, Wojtyniak BJ, Zarkov Z, Kessler RC, Chatterji S, Thornicroft G. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med 2018; 48:1560-1571. [PMID: 29173244 PMCID: PMC6878971 DOI: 10.1017/s0033291717003336] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. METHODS Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). RESULTS Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). CONCLUSIONS The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
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Affiliation(s)
- S. Evans-Lacko
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
- PSSRU, London School of Economics and Political Science,
Houghton Street, London WC2A 2AE, United Kingdom
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health
System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya
governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar
Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF),
Barcelona, Spain; and CIBER en Epidemiología y Salud Pública
(CIBERESP), Barcelona, Spain
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research,
National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City,
Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke
Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - W.T. Chiu
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - S. Florescu
- National School of Public Health, Management and
Development, Bucharest, Romania
| | - G. de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry,
Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical
Research Centre, Via Pilastroni 4, Brescia, Italy
| | - O. Gureje
- Department of Psychiatry, University College Hospital,
Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM,
Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Y. He
- Shanghai Mental Health Center, Shanghai Jiao Tong
University, School of Medicine, Shanghai, China
| | - C. Hu
- Shenzhen Institute of Mental Health & Shenzhen
Kangning Hospital, Shenzhen, China
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, St
George Hospital University Medical Center, Balamand University, Faculty of Medicine,
Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care
(IDRAAC), Beirut, Lebanon
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The
University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong
Kong, Tai Po, Hong Kong
| | - C. Lund
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
- Alan J Flisher Centre for Public Mental Health,
Department of Psychiatry and Mental Health, University of Cape Town, South
Africa
| | - V. Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP),
EA 4057, Paris Descartes University, Paris, France
| | - D. Levinson
- Mental Health Services, Ministry of Health, Jerusalem,
Israel
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de
Planificación, Innovación y Cronicidad, Servicio Murciano de Salud.
IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - B. E. Pennell
- Survey Research Center, Institute for Social Research,
University of Michigan, Ann Arbor, Michigan, USA
| | - N.A. Sampson
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - K.M. Scott
- Department of Psychological Medicine, University of
Otago, Dunedin, Otago, New Zealand
| | - H. Tachimori
- National Institute of Mental Health, National Center for
Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health
and Addiction, Utrecht, Netherlands
| | - M. C. Viana
- Department of Social Medicine, Federal University of
Espírito Santo, Vitoria, Brazil
| | - D. R. Williams
- Department of Society, Human Development, and Health,
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - B. J. Wojtyniak
- Centre of Monitoring and Analyses of Population Health,
National Institute of Public Health-National Institute of Hygiene, Warsaw,
Poland
| | - Z. Zarkov
- Directorate of Mental Health, National Center of Public
Health and Analyses, Sofia, Bulgaria
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - S. Chatterji
- Department of Information, Evidence and Research, World
Health Organization, Geneva, Switzerland
| | - G. Thornicroft
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
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13
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Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Have MT, Zarkov Z, Kessler RC, Thornicroft G. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety 2018; 35:195-208. [PMID: 29356216 PMCID: PMC6008788 DOI: 10.1002/da.22711] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/20/2017] [Accepted: 11/25/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | - Sara Evans-Lacko
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,PSSRU, London School of Economics and Political Science, London, United Kingdom
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Somnath Chatterji
- Department of Information, Evidence and Research,World Health Organization, Geneva, Switzerland
| | - Jibril Abdulmalik
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Graça Cardoso
- Department of Mental Health, Faculdades de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS-St. John of God Clinical Research Centre, Brescia, Italy
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon,Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Zahari Zarkov
- Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Graham Thornicroft
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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14
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Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O'Neill S, Pennell BE, Scott K, Ten Have M, Torres Y, Zaslavsky AM, Zarkov Z, Bruffaerts R. Mental disorders among college students in the World Health Organization World Mental Health Surveys - CORRIGENDUM. Psychol Med 2017; 47:2737. [PMID: 28462760 DOI: 10.1017/s0033291717001039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Degenhardt L, Glantz M, Evans‐Lacko S, Sadikova E, Sampson N, Thornicroft G, Aguilar‐Gaxiola S, Al‐Hamzawi A, Alonso J, Helena Andrade L, Bruffaerts R, Bunting B, Bromet EJ, Miguel Caldas de Almeida J, de Girolamo G, Florescu S, Gureje O, Maria Haro J, Huang Y, Karam A, Karam EG, Kiejna A, Lee S, Lepine J, Levinson D, Elena Medina‐Mora M, Nakamura Y, Navarro‐Mateu F, Pennell B, Posada‐Villa J, Scott K, Stein DJ, ten Have M, Torres Y, Zarkov Z, Chatterji S, Kessler RC. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys. World Psychiatry 2017; 16:299-307. [PMID: 28941090 PMCID: PMC5608813 DOI: 10.1002/wps.20457] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South WalesSydneyAustralia
| | - Meyer Glantz
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of HealthBethesdaMDUSA
| | - Sara Evans‐Lacko
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | | | - Nancy Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | | | - Ali Al‐Hamzawi
- College of MedicineAl‐Qadisiya UniversityDiwaniya GovernorateIraq
| | - Jordi Alonso
- Health Services Research Unit, Hospital del Mar Medical Research Institute; Pompeu Fabra University; and CIBER en Epidemiología y Salud PúblicaBarcelonaSpain
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology, Institute of Psychiatry, University of São Paulo Medical SchoolSão PauloBrazil
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum ‐ Katholieke Universiteit Leuven, Campus GasthuisbergLeuvenBelgium
| | | | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of MedicineStony BrookNYUSA
| | - José Miguel Caldas de Almeida
- Chronic Diseases Research Center and Department of Mental HealthFaculdade de Ciências Médicas, Universidade Nova de LisboaLisbonPortugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Professional DevelopmentBucharestRomania
| | - Oye Gureje
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de BarcelonaBarcelonaSpain
| | - Yueqin Huang
- Institute of Mental Health, Peking UniversityBeijingChina
| | - Aimee Karam
- Institute for Development, Research, Advocacy and Applied CareBeirutLebanon
| | - Elie G. Karam
- Institute for Development, Research, Advocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand University Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical CenterBeirutLebanon
| | - Andrzej Kiejna
- Wroclaw Medical University, University of Lower SilesiaWroclawPoland
| | - Sing Lee
- Department of PsychiatryChinese University of Hong KongTai PoHong Kong
| | - Jean‐Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR‐S 1144, Paris Diderot and Paris Descartes UniversitiesParisFrance
| | | | | | | | - Fernando Navarro‐Mateu
- Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de SaludMurciaSpain
| | | | | | - Kate Scott
- Department of Psychological MedicineUniversity of OtagoDunedinOtagoNew Zealand
| | - Dan J. Stein
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Margreet ten Have
- Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES UniversityMedellinColombia
| | - Zahari Zarkov
- Directorate for Mental Health, National Center of Public Health and AnalysesSofiaBulgaria
| | - Somnath Chatterji
- Department of InformationEvidence and Research, World Health OrganizationGenevaSwitzerland
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16
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Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, Bunting B, de Girolamo G, Demyttenaere K, Florescu SE, Gureje O, Hisateru T, Hu C, Huang Y, Karam E, Kiejna A, Lepine JP, Navarro-Mateu F, Browne MO, Piazza M, Posada-Villa J, ten Have ML, Torres Y, Xavier M, Zarkov Z, Kessler RC, Scott KM, de Jonge P. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47:1744-1760. [PMID: 28222820 PMCID: PMC5674525 DOI: 10.1017/s0033291717000174] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. METHOD Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. RESULTS The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. CONCLUSIONS Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
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Affiliation(s)
- Klaas J. Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Carmen C.W. Lim
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jordi Alonso
- Health Services Research Unit, Instituto Hospital del Mar de Investigaciones Médicas, Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Laura H. Andrade
- Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Brendan Bunting
- Psychology Research Institute, Ulster University, Londonderry, United Kingdom
| | | | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Tachi Hisateru
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Japan
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - Elie Karam
- St George Hospital University Medical Center, Balamand University, Institute for Development, Research, Advocacy, Beirut, Lebanon
| | - Andrzej Kiejna
- Department of Psychiatry Wroclaw Medical University, Wroclaw, Poland
| | - Jean Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes Paris, France
| | - Fernando Navarro-Mateu
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca. Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP)-Murcia. Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | | | - Maria Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, St Martin de Porres, Peru
| | | | - Margreet L. ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Miguel Xavier
- Nova faculdade ciencias medicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Zahari Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | | | - Kate M. Scott
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
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17
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Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O'Neill S, Pennell BE, Scott K, Ten Have M, Torres Y, Zaslavsky AM, Zarkov Z, Bruffaerts R. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med 2016; 46:2955-2970. [PMID: 27484622 DOI: 10.1017/s003329176001665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. METHOD The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18-22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI). RESULTS One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders. CONCLUSIONS Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.
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Affiliation(s)
- R P Auerbach
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - J Alonso
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM),Barcelona,Spain
| | - W G Axinn
- Department of Sociology,Population Studies Center, Survey Research Center, Institute for Social Research, University of Michigan,Ann Arbor, MI,USA
| | - P Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology,Vrije Universiteit Amsterdam,Amsterdam,The Netherlands
| | - D D Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy,Friedrich-Alexander University Nuremberg-Erlangen,Erlangen,Germany
| | - J G Green
- School of Education, Boston University,Boston, MA,USA
| | - I Hwang
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - R C Kessler
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - H Liu
- Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston, MA,USA
| | - P Mortier
- Research Group Psychiatry,Department of Neurosciences,KU Leuven University,Leuven,Belgium
| | - M K Nock
- Department of Psychology,Harvard University,Cambridge, MA,USA
| | - S Pinder-Amaker
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - N A Sampson
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - S Aguilar-Gaxiola
- University of California Davis Center for Reducing Health Disparities,School of Medicine,Sacramento, CA,USA
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University,Diwania Governorate,Iraq
| | - L H Andrade
- Section of Psychiatric Epidemiology - LIM 23,Institute of Psychiatry, University of São Paulo Medical School,São Paulo,Brazil
| | - C Benjet
- Department of Epidemiologic and Psychosocial Research,National Institute of Psychiatry Ramón de la Fuente Muñiz,Mexico City,Mexico
| | - J M Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health,Faculdade de Ciências Médicas,Universidade Nova de Lisboa,Lisbon,Portugal
| | - K Demyttenaere
- Department of Psychiatry,University Hospital Gasthuisberg, Katholieke Universiteit Leuven,Leuven,Belgium
| | - S Florescu
- National School of Public Health, Management and Professional Development,Bucharest,Romania
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre,Brescia,Italy
| | - O Gureje
- Department of Psychiatry,University College Hospital,Ibadan,Nigeria
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona,Barcelona,Spain
| | - E G Karam
- Department of Psychiatry and Clinical Psychology,Faculty of Medicine,Balamand University,Beirut,Lebanon
| | - A Kiejna
- Department of Psychiatry,Wroclaw Medical University,Wroclaw,Poland
| | - V Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris,France
| | - S Lee
- Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong
| | - J J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health,Wacol,Queensland,Australia
| | - S O'Neill
- School of Psychology, University of Ulster,Londonderry,UK
| | - B-E Pennell
- Survey Research Center, Institute for Social Research, University of Michigan,Ann Arbor, MI,USA
| | - K Scott
- Department of Psychological Medicine,University of Otago,Dunedin,Otago,New Zealand
| | - M Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction,Utrecht,the Netherlands
| | - Y Torres
- Center for Excellence on Research in Mental Health, CES University,Medellín,Colombia
| | - A M Zaslavsky
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - Z Zarkov
- Department Mental Health,National Center of Public Health and Analyses,Sofia,Bulgaria
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium
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Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O’Neill S, Pennell BE, Scott K, ten Have M, Torres Y, Zaslavsky AM, Zarkov Z, Bruffaerts R. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med 2016; 46:2955-2970. [PMID: 27484622 PMCID: PMC5129654 DOI: 10.1017/s0033291716001665] [Citation(s) in RCA: 597] [Impact Index Per Article: 74.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. METHOD The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18-22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI). RESULTS One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders. CONCLUSIONS Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.
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Affiliation(s)
- Randy P. Auerbach
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d’Investigacions Mèdiques; CIBERESP-CIBER en Epidemiolgía y Salud Pública; Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - William G. Axinn
- Population Studies Center, Survey Research Center, Institute for Social Research and the Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - David D. Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Liu
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Philippe Mortier
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- University of California Davis Center for Reducing Health Disparities, Sacramento, California,, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - Laura H. Andrade
- Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | | | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Spain
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
| | - Sing Lee
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - John J. McGrath
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Siobhan O’Neill
- School of Psychology, University of Ulster, Londonderry, United Kingdom
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Department Mental Health, Sofia, Bulgaria
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
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19
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Benjet C, Bromet E, Karam EG, Kessler RC, McLaughlin KA, Ruscio AM, Shahly V, Stein DJ, Petukhova M, Hill E, Alonso J, Atwoli L, Bunting B, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Huang Y, Lepine JP, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Shalev A, Slade T, ten Have M, Torres Y, Viana MC, Zarkov Z, Koenen KC. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med 2016; 46:327-343. [PMID: 26511595 PMCID: PMC4869975 DOI: 10.1017/s0033291715001981] [Citation(s) in RCA: 584] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
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Affiliation(s)
- C. Benjet
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - E. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, New York, NY, USA
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - A. M. Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - M. Petukhova
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - E. Hill
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - L. Atwoli
- Moi University School of Medicine, Eldoret, Uasin Gishu, Kenya
| | - B. Bunting
- School of Psychology, University of Ulster, Northern Ireland, UK
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - J. M. Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre, Brescia, Italy
| | - S. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, People’s Republic of China
| | - J. P. Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - M. E. Medina-Mora
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - F. Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M. Piazza
- National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - A. Shalev
- NYU School of Medicine, New York, NY, USA
| | - T. Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M. ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Z. Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - K. C. Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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20
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Silove D, Alonso J, Bromet E, Gruber M, Sampson N, Scott K, Andrade L, Benjet C, de Almeida JMC, De Girolamo G, de Jonge P, Demyttenaere K, Fiestas F, Florescu S, Gureje O, He Y, Karam E, Lepine JP, Murphy S, Villa-Posada J, Zarkov Z, Kessler RC. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey. Am J Psychiatry 2015; 172:647-56. [PMID: 26046337 PMCID: PMC5116912 DOI: 10.1176/appi.ajp.2015.14091185] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. METHOD The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. RESULTS Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. CONCLUSIONS Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.
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21
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Wardenaar KJ, van Loo HM, Cai T, Fava M, Gruber MJ, Li J, de Jonge P, Nierenberg AA, Petukhova MV, Rose S, Sampson NA, Schoevers RA, Wilcox MA, Alonso J, Bromet EJ, Bunting B, Florescu SE, Fukao A, Gureje O, Hu C, Huang YQ, Karam AN, Levinson D, Medina Mora ME, Posada-Villa J, Scott KM, Taib NI, Viana MC, Xavier M, Zarkov Z, Kessler RC. The effects of co-morbidity in defining major depression subtypes associated with long-term course and severity. Psychol Med 2014; 44:3289-3302. [PMID: 25066141 PMCID: PMC4180779 DOI: 10.1017/s0033291714000993] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although variation in the long-term course of major depressive disorder (MDD) is not strongly predicted by existing symptom subtype distinctions, recent research suggests that prediction can be improved by using machine learning methods. However, it is not known whether these distinctions can be refined by added information about co-morbid conditions. The current report presents results on this question. METHOD Data came from 8261 respondents with lifetime DSM-IV MDD in the World Health Organization (WHO) World Mental Health (WMH) Surveys. Outcomes included four retrospectively reported measures of persistence/severity of course (years in episode; years in chronic episodes; hospitalization for MDD; disability due to MDD). Machine learning methods (regression tree analysis; lasso, ridge and elastic net penalized regression) followed by k-means cluster analysis were used to augment previously detected subtypes with information about prior co-morbidity to predict these outcomes. RESULTS Predicted values were strongly correlated across outcomes. Cluster analysis of predicted values found three clusters with consistently high, intermediate or low values. The high-risk cluster (32.4% of cases) accounted for 56.6-72.9% of high persistence, high chronicity, hospitalization and disability. This high-risk cluster had both higher sensitivity and likelihood ratio positive (LR+; relative proportions of cases in the high-risk cluster versus other clusters having the adverse outcomes) than in a parallel analysis that excluded measures of co-morbidity as predictors. CONCLUSIONS Although the results using the retrospective data reported here suggest that useful MDD subtyping distinctions can be made with machine learning and clustering across multiple indicators of illness persistence/severity, replication with prospective data is needed to confirm this preliminary conclusion.
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Affiliation(s)
- K J Wardenaar
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,The Netherlands
| | - H M van Loo
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,The Netherlands
| | - T Cai
- Department of Biostatistics,Harvard School of Public Health,Boston, MA,USA
| | - M Fava
- Department of Psychiatry,MGH Clinical Trials Network and Institute,Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA,USA
| | - M J Gruber
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - J Li
- Department of Biostatistics,Harvard School of Public Health,Boston, MA,USA
| | - P de Jonge
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,The Netherlands
| | - A A Nierenberg
- Depression Clinical and Research Program and the Bipolar Clinic and Research Program,Massachusetts General Hospital and Harvard Medical School,Boston, MA,USA
| | - M V Petukhova
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - S Rose
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - N A Sampson
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
| | - R A Schoevers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,The Netherlands
| | - M A Wilcox
- Johnson & Johnson Pharmaceutical Research and Development,Titusville, NJ,USA
| | - J Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar,Pompeu Fabra University (UPF), andCIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona,Spain
| | - E J Bromet
- Department of Psychiatry and Behavioral Science, Stony Brook School of Medicine,State University of New York at Stony Brook,Stony Brook, NY,USA
| | - B Bunting
- Psychology Research Institute,University of Ulster,Londonderry,UK
| | - S E Florescu
- National School of Public Health,Management and Professional Development, Bucharest,Romania
| | - A Fukao
- Department of Public Health,Yamagata University School of Medicine,Japan
| | - O Gureje
- University College Hospital,Ibadan,Nigeria
| | - C Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital,Guangdong Province,People's Republic of China
| | - Y Q Huang
- Institute of Mental Health, Peking University,Beijing,People's Republic of China
| | - A N Karam
- Department of Psychiatry and Clinical Psychology,St George Hospital University Medical Center,Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, andInstitute for Development Research Advocacy and Applied Care (IDRAAC), Beirut,Lebanon
| | - D Levinson
- Research and Planning,Mental Health Services,Ministry of Health, Jerusalem,Israel
| | - M E Medina Mora
- National Institute of Psychiatry,Calzada Mexico Xochimilco, Mexico City,Mexico
| | - J Posada-Villa
- Universidad Colegio Mayor de Cundinamarca,Bogota,Colombia
| | - K M Scott
- Department of Psychological Medicine,University of Otago,Dunedin,New Zealand
| | - N I Taib
- Mental Health Center-Duhok,Kurdistan Region,Iraq
| | - M C Viana
- Department of Social Medicine,Federal University of Espirito Santo,Vitoria,Brazil
| | - M Xavier
- Department of Mental Health,Universidade Nova de Lisboa,Lisbon,Portugal
| | - Z Zarkov
- National Center of Public Health and Analyses,Department of Mental Health, Sofia,Bulgaria
| | - R C Kessler
- Department of Health Care Policy,Harvard Medical School,Boston, MA,USA
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22
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van Loo HM, Cai T, Gruber MJ, Li J, de Jonge P, Petukhova M, Rose S, Sampson NA, Schoevers RA, Wardenaar KJ, Wilcox MA, Al-Hamzawi AO, Andrade LH, Bromet EJ, Bunting B, Fayyad J, Florescu SE, Gureje O, Hu C, Huang Y, Levinson D, Medina-Mora ME, Nakane Y, Posada-Villa J, Scott KM, Xavier M, Zarkov Z, Kessler RC. Major depressive disorder subtypes to predict long-term course. Depress Anxiety 2014; 31:765-77. [PMID: 24425049 PMCID: PMC5125445 DOI: 10.1002/da.22233] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/05/2013] [Accepted: 12/07/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Variation in the course of major depressive disorder (MDD) is not strongly predicted by existing subtype distinctions. A new subtyping approach is considered here. METHODS Two data mining techniques, ensemble recursive partitioning and Lasso generalized linear models (GLMs), followed by k-means cluster analysis are used to search for subtypes based on index episode symptoms predicting subsequent MDD course in the World Mental Health (WMH) surveys. The WMH surveys are community surveys in 16 countries. Lifetime DSM-IV MDD was reported by 8,261 respondents. Retrospectively reported outcomes included measures of persistence (number of years with an episode, number of years with an episode lasting most of the year) and severity (hospitalization for MDD, disability due to MDD). RESULTS Recursive partitioning found significant clusters defined by the conjunctions of early onset, suicidality, and anxiety (irritability, panic, nervousness-worry-anxiety) during the index episode. GLMs found additional associations involving a number of individual symptoms. Predicted values of the four outcomes were strongly correlated. Cluster analysis of these predicted values found three clusters having consistently high, intermediate, or low predicted scores across all outcomes. The high-risk cluster (30.0% of respondents) accounted for 52.9-69.7% of high persistence and severity, and it was most strongly predicted by index episode severe dysphoria, suicidality, anxiety, and early onset. A total symptom count, in comparison, was not a significant predictor. CONCLUSIONS Despite being based on retrospective reports, results suggest that useful MDD subtyping distinctions can be made using data mining methods. Further studies are needed to test and expand these results with prospective data.
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Affiliation(s)
- Hanna M. van Loo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Michael J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Junlong Li
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Peter de Jonge
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sherri Rose
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Klaas J. Wardenaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Marsha A. Wilcox
- Johnson and Johnson Pharmaceutical Research and Development, Titusville, NJ, USA
| | | | - Laura Helena Andrade
- Section of Psychiatric Epidemiology-LIM 23 Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Evelyn J. Bromet
- State University of New York at Stony Brook, Stony Brook, New York, USA
| | - Brendan Bunting
- Psychology Research Institute, University of Ulster, Londonderry, UK
| | - John Fayyad
- Institute for Development Research, Advocacy, and Applied Care and St.George Hospital University Medical Center, Beirut, Lebanon
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, People's Republic of China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, People's Republic of China
| | - Daphna Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Yoshibumi Nakane
- Department of Social Work, The Faculty of Human Sociology, Nagasaki International University, Nagasaki, Japan
| | | | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Miguel Xavier
- Department of Mental Health, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- National Center of Public Health and Analyses Department Mental Health, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Address correspondence to Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. Tel. (617) 432-3587, Fax (617) 432-3588,
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23
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Karam EG, Sampson N, Itani L, Andrade LH, Borges G, Chiu WT, Florescu S, Horiguchi I, Zarkov Z, Akiskal H. Under-reporting bipolar disorder in large-scale epidemiologic studies. J Affect Disord 2014; 159:147-54. [PMID: 24679403 DOI: 10.1016/j.jad.2014.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/31/2013] [Accepted: 01/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND To investigate if the prevalence of bipolar disorder in epidemiologic studies is an underestimate, as suggested by clinical studies. METHODS We analyzed data from 8 countries that participated in the World Mental Health Survey Initiative (n=47,552). We identified 6.8% and 18.9% of the sample who we think were screened out inappropriately (SCI) from the euphoric and irritable bipolar sections respectively. We compared them to those who were allowed to continue the section (CONT, 2.6% of the sample for euphoric; 1.0% for irritable) and to the reference group (REF, 69.5% of the sample). RESULTS The SCI group had consistently higher rates of major depression (29.1% vs. 6.4%), earlier age of onset (24.3y vs. 32.4y), more suicide attempts (13.3% vs. 5.9%), and more episodes (4.2 vs. 2.7) than the REF for the euphoric group. Similar findings exist for the irritable group. Also, comorbidity with anxiety, disruptive behavior disorders and substance use were much higher than the REF. LIMITATIONS As with all epidemiologic studies, recall bias cannot be ruled out. CONCLUSIONS The findings above suggest that a number of the SCI subjects belong to the bipolar group. A revision of instruments used in epidemiologic research will probably prove what clinical studies have been showing that bipolar disorder is more common than has been reported.
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Affiliation(s)
- Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon.
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Lynn Itani
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Laura Helena Andrade
- Institute of Psychiatry, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | | | - Zahari Zarkov
- National Center of Public Health and Analyses, Department Mental Health, Sofia, Bulgaria
| | - Hagop Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA
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24
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Karam EG, Friedman MJ, Hill ED, Kessler RC, McLaughlin KA, Petukhova M, Sampson L, Shahly V, Angermeyer MC, Bromet EJ, de Girolamo G, de Graaf R, Demyttenaere K, Ferry F, Florescu SE, Haro JM, He Y, Karam AN, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Browne MAO, Posada-Villa JA, Shalev AY, Stein DJ, Viana MC, Zarkov Z, Koenen KC. Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depress Anxiety 2014; 31:130-42. [PMID: 23983056 PMCID: PMC4085043 DOI: 10.1002/da.22169] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/03/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. METHODS Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. RESULTS 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. CONCLUSIONS A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies.
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Affiliation(s)
- Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
| | - Matthew J. Friedman
- U.S. Department of Veterans Affairs, National Center for PTSD, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Eric D. Hill
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Katie A. McLaughlin
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Laura Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Victoria Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Evelyn J. Bromet
- Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, New York
| | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, the Netherlands
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, University Hospital, Leuven, Belgium
| | - Finola Ferry
- MRC Trial Methodology Hub, Bamford Centre for Mental Health and Wellbeing, University of Ulster, Londonderry, United Kingdom
| | - Silvia E. Florescu
- Public Health Research and Evidence Based Medicine Department, National School of Public Health and Health Services Management, Bucharest, Romania
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yanling He
- Department of Clinical Epidemiology, Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Aimee N. Karam
- Department of Psychiatry and Clinical Psychology, Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Department of Epidemiology, EHESP School for Public Health, Université Paris Descartes, Paris, France
| | | | - Mark A. Oakley Browne
- Statewide and Mental Health Services, Department of Health and Human Services, Tasmania, Australia
| | | | - Arieh Y. Shalev
- Department of Psychiatry, Hadassah University Hospital, Kiriat Hadassah, Jerusalem, Israel
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitoria, Espírito Santo, Brazil
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Karestan C. Koenen
- Psychiatric-Neurological Epidemiology Cluster Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York,Correspondence to: Karestan C. Koenen, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 720G, New York, NY 10032.
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25
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Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, Bruffaerts R, Caldas-de-Almeida JM, Florescu S, de Girolamo G, Gureje O, He Y, Hu C, de Jonge P, Karam EG, Kovess-Masfety V, Medina-Mora ME, Moskalewicz J, Murphy S, Nakamura Y, Piazza M, Posada-Villa J, Stein DJ, Taib NI, Zarkov Z, Kessler RC, Scott KM. Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psychooncology 2014; 23:40-51. [PMID: 23983079 PMCID: PMC3992888 DOI: 10.1002/pon.3372] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. METHODS Data were derived from the World Mental Health Surveys (N = 66,387; n = 357 active cancer, n = 1373 cancer survivors, n = 64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12 months. Cancer status was ascertained by self-report of physician's diagnosis. RESULTS Twelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE = 2.1) than cancer-free respondents (13.3%, SE = 0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR) = 1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE = 0.9) compared with cancer-free respondents did not differ significantly (AOR = 0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12 months, 59% sought services for mental health problems (SE = 5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE = 6.0; 41.2%, SE = 3.0; 35.6%, SE = 0.6) and low-middle-income countries (46.4%, SE = 11.0; 22.5%, SE = 9.1; 17.4%, SE = 0.7). CONCLUSIONS Community respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors.
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Affiliation(s)
- Ora Nakash
- School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare & Health Sciences, Haifa University, Haifa, Israel
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities (CRHD), Community Engagement Program of the Clinical Translational Science Center (CTSC), University of California, Davis, School of Medicine, Sacramento, CA, US
| | - Jordi Alonso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Institute of Psychiatry University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon, Portugal
| | - Slivia Florescu
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania
| | | | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Yanling He
- Shangai Mental Health Center, Shangai, PR China
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Peter de Jonge
- University Medical Center Groningen, Groningen, The Netherlands
| | - Elie G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC) Medical Institute for Neuropsychological Disorders (MIND); Department of Psychiatry & Clinical Psychology St. George Hospital University Medical Center Balamand University, Faculty of Medicine Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Department of Epidemiology and Biostatistics, Paris Descartes University research Unit EHESP School for Public Health, Paris, France
| | | | | | | | | | | | | | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, South Africa
| | | | - Zahari Zarkov
- National Center of Public Health and Analyses, Department of Mental Health, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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26
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Ahmedani BK, Kubiak SP, Kessler RC, de Graaf R, Alonso J, Bruffaerts R, Zarkov Z, Viana MC, Huang YQ, Hu C, Posada-Villa JA, Lepine JP, Angermeyer MC, de Girolamo G, Karam AN, Medina-Mora ME, Gureje O, Ferry F, Sagar R, Anthony JC. Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study. Psychol Med 2013; 43:2191-2202. [PMID: 23298443 PMCID: PMC4013530 DOI: 10.1017/s003329171200298x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study. METHOD In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions. RESULTS There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p<0.001), even with covariate adjustments for age and sex. CONCLUSIONS . The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
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Affiliation(s)
- B K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA.
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27
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Kovess-Masfety V, Alonso J, Angermeyer M, Bromet E, de Girolamo G, de Jonge P, Demyttenaere K, Florescu SE, Gruber MJ, Gureje O, Hu C, Huang Y, Karam EG, Jin R, Lépine JP, Levinson D, McLaughlin KA, Medina-Mora ME, O’Neill S, Ono Y, Posada-Villa JA, Sampson NA, Scott KM, Shahly V, Stein DJ, Viana MC, Zarkov Z, Kessler RC. Irritable mood in adult major depressive disorder: results from the world mental health surveys. Depress Anxiety 2013; 30:395-406. [PMID: 23364997 PMCID: PMC4117370 DOI: 10.1002/da.22033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/07/2012] [Accepted: 11/11/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although irritability is a core symptom of DSM-IV major depressive disorder (MDD) for youth but not adults, clinical studies find comparable rates of irritability between nonbipolar depressed adults and youth. Including irritability as a core symptom of adult MDD would allow detection of depression-equivalent syndromes with primary irritability hypothesized to be more common among males than females. We carried out a preliminary examination of this issue using cross-national community-based survey data from 21 countries in the World Mental Health (WMH) Surveys (n = 110,729). METHODS The assessment of MDD in the WHO Composite International Diagnostic Interview includes one question about persistent irritability. We examined two expansions of the definition of MDD involving this question: (1) cases with dysphoria and/or anhedonia and exactly four of nine Criterion A symptoms plus irritability; and (2) cases with two or more weeks of irritability plus four or more other Criterion A MDD symptoms in the absence of dysphoria or anhedonia. RESULTS Adding irritability as a tenth Criterion A symptom increased lifetime prevalence by 0.4% (from 11.2 to 11.6%). Adding episodes of persistent irritability increased prevalence by an additional 0.2%. Proportional prevalence increases were significantly higher, but nonetheless small, among males compared to females. Rates of severe role impairment were significantly lower among respondents with this irritable depression who did not meet conventional DSM-IV criteria than those with DSM-IV MDD. CONCLUSION Although limited by the superficial assessment in this single question on irritability, results do not support expanding adult MDD criteria to include irritable mood.
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Affiliation(s)
- Viviane Kovess-Masfety
- Université Paris Descartes & EHESP School for Public Health Department of Epidemiology, Paris, France.
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Evelyn Bromet
- Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, New York
| | | | - Peter de Jonge
- University Medical Center Groningen, Groningen, The Netherlands
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, University Hospital, Leuven, Belgium
| | - Silvia E. Florescu
- Public Health Research and Evidence Based Medicine Department, National School of Public Health and Health Services Management, Bucharest, Romania
| | - Michael J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
| | - Robert Jin
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Katie A. McLaughlin
- Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | | | - Siobhan O’Neill
- School of Psychology, University of Ulster, Londonderry, United Kingdom
| | - Yutaka Ono
- National Center for Neurology and Psychiatry, Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Victoria Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, South Africa
| | - Maria C. Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Department Mental Health, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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28
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Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011; 68:241-51. [PMID: 21383262 PMCID: PMC3486639 DOI: 10.1001/archgenpsychiatry.2011.12] [Citation(s) in RCA: 1560] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. OBJECTIVES To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. MAIN OUTCOME MEASURES Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. RESULTS The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. CONCLUSIONS Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
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29
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Lee S, Tsang A, Kessler RC, Jin R, Sampson N, Andrade L, Karam EG, Mora MEM, Merikangas K, Nakane Y, Popovici DG, Posada-Villa J, Sagar R, Wells JE, Zarkov Z, Petukhova M. Rapid-cycling bipolar disorder: cross-national community study. Br J Psychiatry 2010; 196:217-25. [PMID: 20194545 PMCID: PMC2830056 DOI: 10.1192/bjp.bp.109.067843] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The epidemiology of rapid-cycling bipolar disorder in the community is largely unknown. AIMS To investigate the epidemiological characteristics of rapid-cycling and non-rapid-cycling bipolar disorder in a large cross-national community sample. METHOD The Composite International Diagnostic Interview (CIDI version 3.0) was used to examine the prevalence, severity, comorbidity, impairment, suicidality, sociodemographics, childhood adversity and treatment of rapid-cycling and non-rapid-cycling bipolar disorder in ten countries (n = 54 257). RESULTS The 12-month prevalence of rapid-cycling bipolar disorder was 0.3%. Roughly a third and two-fifths of participants with lifetime and 12-month bipolar disorder respectively met criteria for rapid cycling. Compared with the non-rapid-cycling, rapid-cycling bipolar disorder was associated with younger age at onset, higher persistence, more severe depressive symptoms, greater impairment from depressive symptoms, more out-of-role days from mania/hypomania, more anxiety disorders and an increased likelihood of using health services. Associations regarding childhood, family and other sociodemographic correlates were less clear cut. CONCLUSIONS The community epidemiological profile of rapid-cycling bipolar disorder confirms most but not all current clinically based knowledge about the illness.
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Affiliation(s)
- Sing Lee
- Hong Kong Mood Disorders Center, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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