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Cited by 100Mental Health Treatment and AccessTreatment of Major DepressionPsychotherapy Techniques and Applications

Findings from World Mental Health Surveys of the perceived helpfulness of treatment for patients with major depressive disorder

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Harris, Meredith G., Kazdin, Alan E., Chiu, Wai Tat, Sampson, Nancy A., Aguilar-Gaxiola, Sergio, Al-Hamzawi, Ali, Alonso, Jordi, Altwaijri, Yasmin +21 more·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.1107PMC PMC7240636
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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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  • Even though PPV in such an optimal model would still be relatively low, the net benefit would likely be positive given that several suicide prevention interventions are cost-effective even at low PPV.

    “Second, even though PPV in such an optimal model would still be relatively low, the net benefit would likely be positive given that several suicide prevention interventions are cost-effective even at low PPV. 669,670”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [669]

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  1. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute; 2002.
  2. Heeringa SG, Wells JE, Hubbard F, et al. Sample designs and sampling procedures. In: Kessler RC, Ustün TB, eds. The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press; 2008:14-32.

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Authors
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Cardoso, G., Cía, A., Florescu, S., Gureje, O., Hu, C., Karam, E. G., Karam, G., Mneimneh, Z., Navarro-Mateu, F., Oladeji, B. D., O’Neill, S., Scott, K., Slade, T., Torres, Y., Vigo, D., Wojtyniak, B., Zarkov, Z., Ziv, Y., Kessler, R. C., & Collaborators, F. T. W. W. M. H. S.
Affiliations
  • The University of Queensland (AU)
  • Yale University (US)
  • Harvard University (US)
  • Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California
  • University of Al-Qadisiyah (IQ)
  • Universitat Pompeu Fabra (ES)
  • King Faisal Specialist Hospital & Research Centre (SA)
  • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR)
  • University of Lisbon (PT)
  • Anxiety Disorders Center, Buenos Aires, Argentina
  • National School of Public Health, Management and Professional Development (RO)
  • University College Hospital, Ibadan (NG)
  • Shenzhen KangNing Hospital (CN)
  • University of Balamand (LB)
  • University of Michigan (US)
  • UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
  • University of Ulster (GB)
  • University of Otago (NZ)
  • The University of Sydney (AU)
  • Universidad CES (CO)
  • Narodowy Instytut Zdrowia Publicznego PZH – Państwowy Instytut Badawczy (PL)
  • National Center of Public Health and Analyses (BG)
  • Israel Ministry of Health (IL)
Corresponding author
Kessler, Ronald C.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-08-01
Volume
77
Issue
8
Pages
830
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.1107
PMC
PMC7240636
OpenAlex
W3027050869
Cited by
100
References
70
Citations by year
2026: 11 · 2025: 9 · 2024: 17 · 2023: 15 · 2022: 23 · 2021: 18 · 2020: 7
FWCI
17.22
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • National Institute of Mental Health (R13-MH-066849, R01‐MH070884, R01‐MH069864)
  • National Institute on Drug Abuse (R01DA016558)
  • Fogarty International Center (R03TW006481)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
major depressive disorder, treatment persistence, age at treatment initiation, comorbidities, substance use disorders, anxiety disorders, treatment timing, socioeconomic status, country income level, patient-centered outcomes, World Mental Health Surveys, help-seeking, helplessness and hopelessness, helplessness
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Major Depressive Disorder, Depressive Disorder, Major, Educational Status, Female, Health Surveys, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Patient Compliance, Time Factors, Global Health, Patient Satisfaction, Young Adult

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