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Cited by 31Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report

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Stein, Dan J., Kazdin, Alan E., Ruscio, Ayelet Meron, Chiu, Wai Tat, Sampson, Nancy A., Ziobrowski, Hannah N., Aguilar-Gaxiola, Sergio, Al-Hamzawi, Ali +78 more·2021·BMC Psychiatry
DOI 10.1186/s12888-021-03363-3PMC PMC8351147
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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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  1. [3]Hoffman DL Dukes EM Wittchen HU Human and economic burden of generalized anxiety disorder Depress Anxiety 2008 25 1 72 90 10.1002/da.20257 17146763 · DOI · Paper page
  2. [4]Carl E, Witcraft SM, Kauffman BY, Gillespie EM, Becker ES, Cuijpers P, et al. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cogn Behav Ther. 2020;49(1):1–21. 10.1080/16506073.2018.1560358. PMC7063818 30760112 · DOI · Paper page
  3. [6]Robichaud M, Koerner N, Dugas MJ. Cognitive behavioral treatment for generalized anxiety disorder: from science to practice: Routledge; 2019. 10.4324/9781315709741. · DOI · Paper page
  4. [7]Stein DJ. Evidence-based treatment of anxiety disorders. Int J Psychiatry Clin Pract. 2006;10(sup1):16–21. 24931539
  5. [8]Hoertel N Le Strat Y Blanco C Lavaud P Dubertret C Generalizability of clinical trial results for generalized anxiety disorder to community samples Depress Anxiety. 2012 29 7 614 620 10.1002/da.21937 22495990 · DOI · Paper page
  6. [10]Janiaud P Dal-Ré R Ioannidis JPA Assessment of pragmatism in recently published randomized clinical trials JAMA Intern Med 2018 178 9 1278 1280 10.1001/jamainternmed.2018.3321 30039169 PMC6142963 · DOI
  7. [12]Kazdin AE Research design in clinical psychology (5th ed.) 2017 Boston, MA Pearson
  8. [13]Cocklin AA, Mansell W, Emsley R, McEvoy P, Preston C, Comiskey J, et al. Client perceptions of helpfulness in therapy: a novel video-rating methodology for examining process variables at brief intervals during a single session. Behav Cogn Psychother. 2017;45(6):647–60. 10.1017/S1352465817000273. 28528592 · DOI
  9. [14]Colman E Missinne S Bracke P The role of perceived helpfulness in predicting subjective unmet need and the frequency of health care use Arch Psychiatr Nurs 2014 28 1 43 49 10.1016/j.apnu.2013.10.007 24506986 · DOI
  10. [17]Alang SM McAlpine DD Pathways to mental health services and perceptions about the effectiveness of treatment Soc Ment Health 2019 9 3 388 407 10.1177/2156869318802341 · DOI
  11. [19]Sharma T Bamford M Dodman D Person-centred care: an overview of reviews Contemp Nurse 2015 51 2–3 107 120 10.1080/10376178.2016.1150192 26866531 · DOI
  12. [20]Harris MG Kazdin AE Chiu WT Sampson NA Aguilar-Gaxiola S Al-Hamzawi A Findings from world mental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder JAMA Psychiatry. 2020 77 8 830 841 10.1001/jamapsychiatry.2020.1107 32432716 PMC7240636 · DOI · Paper page
  13. [21]Stein DJ, Harris MG, Vigo DV, Tat Chiu W, Sampson N, Alonso J, et al. Perceived helpfulness of treatment for posttraumatic stress disorder: findings from the world mental health surveys. Depress Anxiety. 2020;37(10):972–94. 10.1002/da.23076. PMC7722199 32667096 · DOI
  14. [22]Kessler RC Ustun TB The WHO mental health surveys. Global perspectives on the epidemiology of mental disorders 2008 Cambridge, England Cambridge University Press
  15. [23]Kessler RC Ustün TB The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI) Int J Methods Psychiatr Res 2004 13 2 93 121 10.1002/mpr.168 15297906 PMC6878592 · DOI · Paper page
  16. [24]Harkness J Pennell B Villar A Gebler N Aguilar-Gaxiola S Bilgen I Kessler R Üstün T Translation procedures and translation assessment in the world mental health survey initiative The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders 2008 New York, NY Cambridge University Press 91 113
  17. [25]Heeringa S Wells J Hubbard F Mneimneh Z Chiu W Sampson N Kessler R Üstün T Sample designs and sampling procedures The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders 2008 New York, NY Cambridge University Press 14 32
  18. [26]Ruscio AM Lane M Roy-Byrne P Stang PE Stein DJ Wittchen H-U Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication Psychol Med 2005 35 12 1761 1772 10.1017/S0033291705005908 16300690 PMC1895923 · DOI
  19. [27]Spitzer M Robert L Gibbon M Williams J Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition (SCID-I/NP) 2002 New York Biometrics Research, New York State Psychiatric Institute
  20. [28]Haro JM Arbabzadeh-Bouchez S Brugha TS De Girolamo G Guyer ME Jin R Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO world mental health surveys Int J Methods Psychiatr Res 2006 15 4 167 180 10.1002/mpr.196 17266013 PMC6878271 · DOI · Paper page
  21. [30]American Psychiatric Association Diagnostic and statistical manual of mental disorders (5th ed) 2013 Washington, DC American Psychiatric Press
  22. [31]Knäuper B Cannell CF Schwarz N Bruce ML Kessler RC Improving accuracy of major depression age-of-onset reports in the US National Comorbidity Survey Int J Methods Psychiatr Res 1999 8 1 39 48 10.1002/mpr.55 · DOI · Paper page
  23. [33]Halli SS Rao KV Advanced techniques of population analysis 2013 Springer Science & Business Media Boston, MA
  24. [34]Willett JB Singer JD Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence J Conult Clin Psychol 1993 61 6 952 965 10.1037/0022-006X.61.6.952 8113496 · DOI
  25. [35]Wolter K Introduction to variance estimation 1985 Springer- Verlag New York, NY
  26. [37]de Vries YA Harris MG Vigo D Chiu WT Sampson NA Al-Hamzawi A Perceived helpfulness of treatment for specific phobia: findings from the world mental health surveys J Affect Disord 2021 288 199 209 10.1016/j.jad.2021.04.001 33940429 PMC8154701 · DOI
  27. [38]Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–87. 10.1176/appi.ajp.162.6.1179. PMC3272761 15930067 · DOI · Paper page
  28. [40]Zlomuzica A Dere D Machulska A Adolph D Dere E Margraf J Episodic memories in anxiety disorders: clinical implications Front Behav Neurosci 2014 8 131 10.3389/fnbeh.2014.00131 24795583 PMC4005957 · DOI
  29. [42]Maj M Helpful treatment of depression-delivering the right messages JAMA Psychiatry. 2020 77 8 784 786 10.1001/jamapsychiatry.2020.0363 32432693 · DOI

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Authors
Stein, D. J., Kazdin, A. E., Ruscio, A. M., Chiu, W. T., Sampson, N. A., Ziobrowski, H. N., 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, J. M., Harris, M. G., Karam, A., Karam, E. G., Kovess-Masfety, V., Lee, S., Medina-Mora, M. E., Moskalewicz, J., Navarro-Mateu, F., Nishi, D., Posada-Villa, J., Scott, K. M., Viana, M. C., Vigo, D. V., Xavier, M., Zarkov, Z., Kessler, R. C., collaborators, O. B. O. T. W. W. M. H. S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Al-Kaisy, M. S., Alonso, J., Altwaijri, Y. A., Andrade, L. H., Atwoli, L., Benjet, C., Borges, G., Bromet, E. J., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., Cardoso, G., Chatterji, S., Cia, A. H., Degenhardt, L., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., Harris, M. G., Hinkov, H., Hu, C.-Y., de Jonge, P., Karam, A. N., Karam, E. G., Kawakami, N., Kessler, R. C., Kiejna, A., Kovess-Masfety, V., Lee, S., Lepine, J.-P., McGrath, J. J., Medina-Mora, M. E., Mneimneh, Z., Moskalewicz, J., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., Scott, K. M., Slade, T., Stagnaro, J. C., Stein, D. J., ten Have, M., Torres, Y., Viana, M. C., Vigo, D. V., Whiteford, H., Williams, D. R., & Wojtyniak, B.
Affiliations
  • Yale University (US)
  • University of Pennsylvania (US)
  • Harvard University (US)
  • National Center of Neurology and Psychiatry (JP)
  • Lisbon Institute of Global Mental Health (PT)
  • National Center of Public Health and Analyses (BG)
  • UC Davis Health (US)
  • Universitat Pompeu Fabra (ES)
  • KU Leuven (BE)
  • UNSW Sydney (AU)
  • Centro San Giovanni di Dio Fatebenefratelli (IT)
  • École des Hautes Études en Santé Publique (FR)
  • Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
  • Institute of Psychiatry and Neurology (PL)
  • Universidad Colegio Mayor de Cundinamarca (CO)
  • South African Medical Research Council (ZA)
  • Universidade Federal do Espírito Santo (BR)
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2021-08-09
Volume
21
Issue
1
Pages
392-392
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-021-03363-3
PMC
PMC8351147
OpenAlex
W3192059233
Cited by
31
References
12
Citations by year
2026: 3 · 2025: 10 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 1
FWCI
4.41
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • Ulster University Research Portal (Ulster University) (submittedVersion, cc-by)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • cIRcle (University of British Columbia) (submittedVersion, cc-by)
  • Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by)
Funders
Please see manuscript
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
generalized anxiety disorder, help-seeking, treatment utilization, prevalence, childhood adversity, panic disorder, agoraphobia, comorbidities, low- and middle-income countries, patient-centered care
MeSH terms
Anxiety Disorders, Health Surveys, Humans, Surveys and Questionnaires, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders

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