Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report.
Por:
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 and WHO World Mental Health Survey collaborators
Publicada:
9 ago 2021
Ahead of Print:
9 ago 2021
Resumen:
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.
Filiaciones:
Stein DJ:
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.
Kazdin AE:
Department of Psychology, Yale University, New Haven, CT, USA
Ruscio AM:
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
Chiu WT:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Sampson NA:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ziobrowski HN:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Aguilar-Gaxiola S:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
Al-Hamzawi A:
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
Alonso J:
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
Altwaijri Y:
Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Bruffaerts R:
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
Bunting B:
School of Psychology, Ulster University, Londonderry, UK
de Girolamo G:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
de Jonge P:
Department of Developmental Psychology, University of Groningen, Groningen, Netherlands
Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
Degenhardt L:
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Gureje O:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Haro JM:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Harris MG:
School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4072, Australia
Karam A:
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
Karam EG:
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
Faculty of Medicine, Balamand University, Beirut, Lebanon
Kovess-Masfety V:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Lee S:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Medina-Mora ME:
National Institute of Psychiatry-Ramón de la Fuente Muñiz, Mexico City, Mexico
Moskalewicz J:
Institute of Psychiatry and Neurology, Warsaw, Poland
Navarro-Mateu F:
UDIF-SM, Servicio Murciano de Salud
IMIB-Arrixaca
CIBERESP-Murcia, Región de Murcia, Murcia, Spain
Nishi D:
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
National Center of Neurology and Psychiatry, Tokyo, Japan
Posada-Villa J:
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Scott KM:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Viana MC:
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
Vigo DV:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Xavier M:
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
Zarkov Z:
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Green Published, gold
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