학술논문
Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report.
Document Type
Academic Journal
Author
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. dan.stein@uct.ac.za.; 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.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 100968559 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-244X (Electronic) Linking ISSN: 1471244X NLM ISO Abbreviation: BMC Psychiatry Subsets: MEDLINE
Subject
Language
English
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.
(© 2021. The Author(s).)
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.
(© 2021. The Author(s).)